Descriptor: "Coronary Artery Bypa" - Searchworks@Jio Institute Digital Library Search Results

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83 results on '"Coronary Artery Bypa"'

1. Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery

Author: Samuele Nanni, Mattia Garofalo, Matteo Schinzari, Elena Nardi, Franco Semprini, Paola Battistini, Francesco Barberini, Alberto Foà, Massimo Baiocchi, Andrea Castelli, Gianluca Folesani, Davide Pacini, Nazzareno Galiè, Anna Corsini, Nanni S., Garofalo M., Schinzari M., Nardi E., Semprini F., Battistini P., Barberini F., Foa A., Baiocchi M., Castelli A., Folesani G., Pacini D., Galie N., and Corsini A.
Subjects: Adult, Male, Pulmonary and Respiratory Medicine, Left ventricular ejection fraction, Prognosi, High-sensitivity cardiac troponin I, Periprocedural myocardial infarction, Myocardial Infarction, Ventricular Function, Left, Retrospective Studie, Coronary artery bypass graft, Humans, Hospital Mortality, Prospective Studies, Coronary Artery Bypass, Retrospective Studies, Coronary Artery Bypa, Troponin I, Stroke Volume, Biomarker, General Medicine, Prognosis, Prospective Studie, Female, Surgery, Cardiology and Cardiovascular Medicine, Biomarkers, Human
Abstract: Background The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and instrumental findings. However, there is not a clear cutoff value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease. Methods We retrospectively enrolled all consecutive adult patients undergoing CABG, alone or in association with other cardiac surgery procedures, over 1 year. Hs-cTn I concentrations (Access, Beckman Coulter) were serially measured in the post-operative period and analyzed according to post-operative outcomes. Results 300 patients were enrolled; 71.3% underwent CABG alone, 33.7% for acute coronary syndrome. Most patients showed hs-cTn I values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, 10.6% showed a LVEF decrease ≥ 10%. Hs-cTn I concentrations did not significantly differ with respect to death and/or PMI whereas they were associated with LVEF decrease ≥ 10% (p value Conclusions Hs-cTn I at 9–12 h post-CABG may be useful to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.
Published: 2022

2. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira 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Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda 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Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira Mokhtar, Noppon Taksaudom, Nor Asiah Basri, Nora Marchelletta, Norma Hogg, Nungshi Jungla, Nuno Ferreira, Oksana A Lubyanaya, Olga B Nikolaeva, Olga Cañavate, Olga Sobrino, Olga Walesiak, Olga Walter, Olga Zdończyk, Olivia J Lim, Olivia Anaya, Olivia Mancilla, Olivier Dubourg, Olugbenga Bello, Omar Almousalli, Omar Thompson, Oni Olurinde, Or Harel, Osama Raheem, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, P Christian Schulze, Pachara Panpunuan, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Julian, Pamela Ouyang, Pamela Sigel, Pamela Woodard, Panpan Zhou, Paola Emanuela Poggio, Paola Smanio, Paolo Calabro, Paramjit Jeetley, Pascal Goube, Patricia K Nguyen, Patricia Alarie, Patricia Arakelian, Patricia Arsenault, Patricia Blaise, Patricia Brito, Patricia Cowper, Patricia Endsley, Patricia Mieses, Patrick B Alexander, Patrick Donnelly, Patrick Wilmot, Patrycja Lebioda, Paul C Gordon, Paul Der Mesropian, Paul Galiwango, Paul Hauptman, Paul Kennedy, Paula Beardsley, Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, Raewyn Fisher, Rafael Beyar, Rafael Diaz, Rafael Selgas, Raffaele Bugiardini, Raffaele Fanelli, Raisa Kavalakkat, V S Rajalekshmi, Rajat S Barua, Rajeev Menon, Rajesh Gopalan Nair, Rajesh Francis, Rajiv Narang, Rakesh Yadav, Ralph Alan Huston, T Ramakrishnan, Ramesh de Silva, Rami El Mahmoud, Ramiro Carvalho, Ramon de Jesús-Pérez, Ramona Stevens, Ran Leng, Ranjan Kachru, Ranjit Kumar Nath, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Raymond W Little, Raymundo Ocaranza Sanchez, Rebecca J Wimmer, Rebecca Bariciano, Rebecca Otis, Rebekah R Herrmann, Reem Yunis, Reinette Hampson, Renato Abdala Karam, Renee C Hessian, Renee Kaneshiro, Reshma Ravindran, Reto Andreas Gamma, Reyna Bhandari, Reza Arsanjani, Ricardo L Lopes, Ricardo Mendes Oliveira, Ricardo Costa, Richa Bhatt, Richard F Davies, Richard H J Trimlett, Richard Goldweit, Rik Hermanides, Rine Nakanishi, Rinu R Sidh, Risha Patel, Rita Coram, Rizwan A Siddiqui, Rob S Beanlands, Robert J Hamburger, Robert K Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020

3. Reconciling the evidence on the treatment of left main coronary artery disease

Author: Ciro Indolfi, Gennaro Giustino, Carmen Spaccarotella, Giustino, G., Spaccarotella, C., and Indolfi, C.
Subjects: medicine.medical_specialty, business.industry, Coronary Artery Bypa, Coronary Artery Disease, Coronary Angiography, Coronary Vessels, Treatment Outcome, Internal medicine, medicine, Cardiology, Humans, Coronary Artery Bypass, Left main coronary artery disease, Cardiology and Cardiovascular Medicine, business, Coronary Vessel, Human
Published: 2020

4. Fractional Flow Reserve–Based Coronary Artery Bypass Surgery: Current Evidence and Future Directions

Author: Spadaccio, C., Glineur, D., Barbato, E., Di Franco, A., Oldroyd, K. G., Biondi-Zoccai, G., Crea, Filippo, Fremes, S. E., Angiolillo, D. J., Gaudino, Mario Fulvio Luigi, Spadaccio, C., Glineur, D., Barbato, E., Di Franco, A., Oldroyd, K. G., Biondi-Zoccai, G., Crea, F., Fremes, S. E., Angiolillo, D. J., and Gaudino, M.
Subjects: Cardiac Catheterization, Coronary Artery Bypa, Predictive Value of Test, Coronary Artery Disease, Coronary Angiography, Fractional Flow Reserve, FFR, Article, Fractional Flow Reserve, Myocardial, surgical procedures, operative, Treatment Outcome, Predictive Value of Tests, myocardial revascularization, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Myocardial, Humans, Coronary Artery Bypass, CABG, Vascular Patency, Human
Abstract: Fractional flow reserve (FFR) provides an objective measurement of the severity of ischemia caused by coronary stenoses in downstream myocardial regions. Data from the interventional cardiology realm have suggested benefits of a FFR-guided percutaneous coronary intervention (PCI) strategy. Limited evidence is available on the use of FFR to guide coronary artery bypass grafting (CABG). The most recent data have shown that FFR might simplify CABG procedures and optimize patency of arterial grafts without any clear impact on clinical outcomes. The aim of this review is to summarize the available data on FFR-based CABG and discuss the rationale and potential consequences of a switch towards FFR-based surgical revascularization strategy.
Published: 2020

5. Health status after invasive or conservative care in coronary and advanced kidney disease

Author: Spertus J. A., Jones P. G., Maron D. J., Mark D. B., O'Brien S. M., Fleg J. L., Reynolds H. R., Stone G. W., Sidhu M. S., Chaitman B. R., Chertow G. M., Hochman J. S., Bangalore S, ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic, Spertus J.A., Jones P.G., Maron D.J., Mark D.B., O'Brien S.M., Fleg J.L., Reynolds H.R., Stone G.W., Sidhu M.S., Chaitman B.R., Chertow G.M., Hochman J.S., Bangalore S, and ISCHEMIA-CKD Research Group: Abdallah M Abdallah, Abel E Moreyra, Abhay A Laddu, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Adedayo Adeboye, Agne Juceviciene, Agne Urboniene, Agnieszka Szramowska, Ahmed Abdel-Latif, Ahmed Ayoub, Ahmed Elghamaz, Ahmed Kamal, Ahmed Talaat, Ajay Sharma, Ajit Singh Narula, Akshay Bagai, Akvile Smigelskaite, Alain Raymond, Alain Rheault, Alaine Melanie Loehr, Albert Varga, Aldo P Maggioni, Alec Moorman, Alejandro Chevaile Ramos, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alexander M Chernyavskiy, Alexander Sergeevich Borisov, Alexandra Craft, Alexandra Hunter, Alexandre Ciappina Hueb, Alexandre Schaan de Quadros, Alice Manica Muller, Aline Peixoto Deiro, Allegra Stone, Almudena Castro, Amar Uxa, Amaryllis Van Craenenbroeck, Ambuj Roy, Amit Kakkar, Amy Flowers, Amy Iskandrian, Ana D Djordjevic-Dikic, Ana Gomes Almeida, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anandaroop Lahiri, Anastasia M Kuzmina-Krutetskaya, Anastasia Vamvakidou, Andras Vertes, Andre Gabriel, Andrea Bartykowszki, Andrea Lorimer, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew Starovoytov, Andrzej Łabyk, Anelise Kawakami, Angela Hoye, Angelo Nobre, Anjali Acharya, Anjali Anand, Anjana Rishmawi, Ann Banfield, Ann Luyten, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Teresinska, Anne Marie Webb, Anne Heath, Anoop Mathew, Antonia Vega, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anu Tharini, Anupama Rao, Aquiles Valdespino-Estrada, Ariel Diaz, Arif Asif, Arnold H Seto, Arturo S Campos-Santaolalla, Asim N Cheema, Asker Ahmed, Atul Mathur, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Balaji Srinivasan, Baljeet Kaur, Balram Bhargava, Bandula Guruge, Barbara Wicklund, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Benoy N Shah, Bernard de Bruyne, Beth Abramson, Beth Stefanchik, Bethany Harvey, Bharati Shivalkar, Bilal Malik, Binoy Mannekkattukudy Kurian, Bougrida Hammouche, Branko D Beleslin, Bruce Ferguson, Bruce McManus, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Carl-Éric Gagné, Carly Ohmart, Carol M Kartje, Caroline Alsweiler, Caroline Rodgers, Caroline Spindler, Carolyn J Gruber, Catherine Albert, Catherine Bone, Catherine Lemay, Cezary Kepka, Chandini Suvarna, Chantale Mercure, Charlene Wiyarand, Chetan Patel, Chiara Attanasio, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Buller, Christel Vassaliere, Christiaan Vrints, Christian Witzke, Christie Ballantyne, Christina Björklund, Christine Roraff, Christophe Laure, Christophe Thuaire, Christopher Chan, Christopher Fordyce, Christopher Kinsey, Chunli Xia, Cidney Schultz, Claes Held, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Clemens T Kadalie, Corine Thobois, Courtney Page, Cristina Bare, Dalisa Espinosa, Dan Gao, Dana Rizk, Daniela Puzhevsky, Data Analyst, David M Charytan, David O Williams, David Booth, David Charytan, David Cohen, David DeMets, David Foo, David Goldfarb, David Schlichting, David Sisson, David Taggart, David Waters, David Wheeler, David Williams, Davis Vo, Dawid Teodorczyk, Dawn D Shelstad, Dean Kereiakes, Deborah Yip, Deepa Ramaswamy, Deirdre Mattina, Deirdre Murphy, Dengke Jiang, Derek Cyr, Diana Cukali, Diane Camara, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Doreen Reimann, Doron Schwartz, Duarte Cacela, Dwayne S G Conway, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Eduardo Gomes Lima, Eduardo Hernandez-Rangel, Edward D Nicol, Edyta Kaczmarska, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise van Dongen, Elissa Restelli Piloto, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizaveta V Zbyshevskaya, Ellie Fridell, Ellis W Lader, Elvira Gosmanova, Emilie Tachot, Emma Howard, Emmanuel Sorbets, Encarnación Alonso-Álvarez, Eric Daugas, Erick Alexánderson Rosas, Estelle Montpetit, Eugene Passamani, Evgeny Shutov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, Fabio Fimiani, Fadi Hage, Fahim Haider Jafary, Fang Feng, Fatima Ranjbaran, Fausto J Pinto, Fernando Caeiro, Fernando Nolasco, Filipa Silva, Filippo Ottani, Firas Al Solaiman, Flávia Egydio, Florina Chereches, Francesca De Micco, Francesca Bianchini, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francisca Patuleia Figueiras, François Madore, Frank Harrell, Frank Rockhold, Frans Van de Werf, Franziska Guenther, Fred Mohr, G Karthikeyan, Gabriel Galeote, Gabriel Grossmann, Gabriel Steg, Gabriela Guzman, Gabriele Gabrielli, Gang Chen, Gautam Sharma, Gaylin Petty, Gelmina Mikolaitiene, Gennie Yee, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Girish Mishra, Gonzalo Barge-Caballero, Grace M Young, Graciela Scaro, Graham Wong, Gregg Pressman, Gregor Simonis, Gudrun Steinmaurer, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillermo Garcia-Garcia, Guoqin Wang, Gurpreet S Wander, Gurpreet Gulati, Haibo Zhang, Halina Marciniak, Hao Dai, Haojian Dong, Harold Franch, Harvey White, Hatem Elabd, Hayley Pomeroy, Heather Golden, Heidi Wilson, Helene Abergel, Hemalata Siddaram, Hemant Shakhar Mahapatra, Henry C Stokes, Hermine Osseni, Herwig Schuchlenz, Hicham Skali, Holly Mattix-Kramer, Hong Cheng, Hossam Mahrous, Hristo Pejkov, Hugo Marques, Hui Zhong, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ikraam Hassan, Ileana L Pina, Ilona Tamasauskiene, Inês Zimbarra Cabrita, Ines Rodrigues, Inga Soveri, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Isabelle Roy, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, Jacek Kusmierek, Jackie Chow, Jaekyeong Heo, Jakub Maksym, James E Davies, James J Jang, James Hirsch, James Tatoulis, Jan Henzel, Janaina Oliveira, Janani Rangaswami, Jane Eckstein, Janitha Raj, Jaqueline Pozzibon, Jaroslaw Drozdz, Jason Loh Kwok Kong, Jason T Call, Jason Linefsky, Javier J Garcia, Jay Meisner, Jayne Scales, Jean Michel Juliard, Jean Diodati, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeff Leimberger, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Stojkovic, Jenne M Jose, Jennifer L Stanford, Jennifer Hogan, Jennifer Horst, Jennifer Isaacs, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jerry Yee, Jessica Berg, Jesus Peteiro, Jesús Peteiro, Jia Li, Jiamin Liu, Jianxin Zhang, Jill Marcus, Jim Blankenship, Jing Dong, Jiyan Chen, Jo Evans, Joaquín V Peñafiel, Joe Sabik, Johann Christopher, John B Kostis, John Joseph Graham, John Doan, John Jose, John Kotter, John Lehman, John Middleton, John Pownall, Jonathan M Gleadle, Jonathan S Chavez-Iñiguez, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Lebowitz, Jonean Thorsen, Jorge Carrillo Calvillo, Jorge Escobedo, José A Ortega-Ramírez, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Costa Vieira, José M Flores-Palacios, Jose Fragata, Jose Lopes, Jose Lopez-Sendon, José Lopez-Sendon, Jose Rueda, Joseph B Selvanayagam, Joseph Sacco, Joshua P Loh, Joy Burkhardt, Juan Manuel López Quijano, Juan Gaztanaga, Judit Sebo, Judith Wright, Juergen Stumpf, Julia de Aveiro Morata, Julio César Figal, Julio Hernandez Jaras, Junqing Yang, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Karen Calfas, Karen Petrosyan, Karen Servilla, Karen Swan, Karin Ploetze, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Katharina Knaut, Katherine Martin, Kathleen Claes, Kathryn Mason, Ken Mahaffey, Kenneth Gin, Kerry Lee, Kerstin Bonin, Kerstin Mikes, Kevin R Bainey, Kevin T Harley, Kevin Marzo, Kevin McMahon, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khrystyna Kushniriuk, Kian-Keong Poh, Kim Holland, Kimberly E Halverson, Kinnari Murphy, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kreton Mavromatis, Krishnakumar Hongalgi, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristine Arges, Kristine Teoh, Krzysztof Drzymalski, Lalathaksha Kumbar, Laszlone Matics, LaTonya J Hickson, Laura Keinaite, Laura Sarti, Laura True, Lawrence M Phillips, Lawrence Friedman, Leandro C Maranan, Leda Lotaif, Lekshmi Dharmarajan, Leo A Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Li Hai Yan, Li Li, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilian Mazza Barbosa, Liljana Tozija, Linda Arcand, Lino Patricio, Liping Zhang, Lisa Hatch, Lixin Jiang, Liz Low, Loay Salman, Lorena Lopez, Lori Pritchard, Luis Bernanrdes, Luis Guzman, Lynette L Teo, M Sowjanya Reddy, Maarten Simoons, Maayan Konigstein, Mafalda Selas, Magdalena Madero, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdy Abdelhamid, Magid Fahim, Mahevamma Mylarappa, Majo X Joseph, Malgorzata Frach, Manjula Rani, Marcello Galvani, Marcin Demkow, Marcin Szkopiak, Marco De Fabritis, Marco Magnoni, Marco Marini, Marco Sicuro, Marek Roik, Maria A Alfonso, Maria Antonieta Pereira de Moraes, María Dolores Martínez-Ruíz, Maria Eugenia Canziani, Maria Eugenia Martin, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Andreasson, Maria Posada, Marianna D A Dracoulakis, Mariano Rubio, Marija T Petrovic, Marina Vieira, Mario J Garcia, Mario D'arezzo, Maris Orgera, Marius Miglinas, Mark Garand, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Swiderek, Martha Meyer, Martina Ceseri, Martinia Tricoli, Mary Wiilliams, Mary Ann Champagne, Mary Streif, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Shinseki, Matthew Weir, Maura Carina Nédio, Max-Paul Winter, Mayil S Krishnam, Meenakshi Mishra, Mei Hwang, Melemadathil Srilatha, Melissa LeFevre, Mengistu Simegn, Michael A Gibson, Michael B Rubens, Michael D Shapiro, Michael Chobanian, Michael Davidson, Michael Farkouh, Michael Mack, Michal Wlodarczyk, Michel G Khouri, Michelle Crowder, Michelle Ratliff, Miguel Borges Santos, Miguel Nobre Menezes, Miguel Perez Fontan, Miguel Barrero, Mihaly Tapolyai, Mikhail T Torosoff, Milan R Dobric, Milind Avdhoot Gadkari, Min Tun Kyaw, Miri Revivo, Mitchel B Lustre, Mohamed Adel, Mohamed Hassan, Mohammad El-Hajjar, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Monika Laukyte, Muhamed Saric, Myrthes Emy Takiuti, Nadia Asif, Nagaraja Moorthy, Naima L Ogletree, Nana O Katamadze, Nandita Nataraj, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Nathalie Brosens, Naved Aslam, Naveed Akhtar, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Neesh Pannu, Neill Duncan, Nevena Garcevic, Ngaire Meadows, Nicholas Danchin, Nicole Deming, Nikola N Boskovic, Nikolaos Karogiannis, Ning Zhang, Nirmal Kumar, Niruta Sharma, Nitika Chadha, Nitish Naik, Noelle M Durfee, Nora M Cosgrove, Norbert Urbanski, Norma Hogg, Olga Walesiak, Olga Zdończyk, Olga Zhdanova, Olivia Anaya, Olugbenga Bello, Omar Almousalli, Omar Thompson, Orit Kliuk, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, Pablo Raffaele, Page Salanger, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Ouyang, Pamela Woodard, Paola Emanuela Poggio Smanio, Paola Smanio, Paolo Calabro, Patricia K Nguyen, Patricia Alarie, Patricia Carrilho, Patricia Endsley, Patricia Pellikka, Patrycja Lebioda, Paul Der Mesropian, Paul Hauptman, Paula García-González, Paula Wilson, Paulo Cury Rezende, Paulo Novis Rocha, Pedro Canas Silva, Pedro Farto E Abreu, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peiyu He, Peter A McCullough, Peter H Stone, Peter Douglass, Peter Sizeland, Peter Voros, Philippe Gabriel Steg, Philippe Genereux, Philippe Généreux, Philippe Menasche, Philippe Rheault, Piero Tassinario, Pierre Gervais, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Poay-Huan Loh, Pouneh Samadi, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puneet Sodhi, Pushpa Naik, Qi Zhong, Qian Zhao, Qianqian Yuan, Qiulan Xie, Rachel Murphy, Radmila Lyubarova, Radmilar Lyubarova, Raewyn Fisher, Rafael Diaz, Rafael Maldonado, Rafael Selgas, Raffaele Bugiardini, Rafia Chaudhry, Raisa Kavalakkat, Rajalekshmi Vs, Rajesh Gopalan Nair, Rajiv Narang, Rakesh Yadav, Ramiro Carvalho, Ramon de Jesús-Pérez, Ran Leng, Ranjan Kachru, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Reinette Hampson, Renato Abdala Karam Kalil, Renato D Lopes, Renato George Eick, Renato Lopes, Reshma Ravindran, Reto Andreas Gamma, Ricardo Costa, Richa Bhatt, Richard H J Trimlett, Risha Patel, Rita Coram, Robert K Riezebos, Robert M Donnino, Robert Guyton, Robert Harrington, Robert Malecki, Roberto René Favaloro, Robyn Elliott, Rodolfo G S D Lima, Rohit Tandon, Rolf Doerr, Roma Tewari, Ron Wald, Rongrong Hu, Rory Collins, Roxana Mehran, Roxy Senior, Rubén Baleón-Espinosa, Ruben Ramos, Rui Ferreira, Ruth Kirby, Ruth Pérez-Fernández, S Ramakrishnan, S K Dwivedi, Sadath Lubna, Sadiq Ahmed, Sajeev Chakanalil Govindan, Salamah Alfalahi, Salvador Cruz-Flores, Salvatore P Costa, Sampoornima Setty, Samuel Nwosu, Sandeep Mahajan, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandy Carr, Sanja Simic Ogrizovic, Sanja Ogrizovic, Sanjeev Gulati, Sanjeev Sharma, Sara Fernandez, Sarah Williams, Sarju Ralhan, Sasko Kedev, Satinder Singh, Satish Sankaranarayanan, Satvic Cholenahally Manjunath, Sau Lee, Schawana Thaxton, Sean M O'Brien, Sebastian Sobczak, Seema Nour, Sergey A Sayganov, Sérgio Bravo Baptista, Sergio Draibe, Seth Sokol, Sharad Chandra, Shari Mackedanz, Shaun Goodman, Shayan Shirazian, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shruti Pandey, Shuyang Zhang, Siddharth Gadage, Sik-Yin V Tan, Sílvia Zottis Poletti, Silvia Valbuena, Simone Savaris, Solomon Yakubov, Songlin Zhu, Sonika Gupta, Sorin Brener, Sothinathan Gurunathan, Soundarya Nayak, Sowjanya Reddy, Stanley E Cobos, Stefan Weikl, Stephanie M Lane, Stephanie Ferket, Stephanie Mavromichalis, Stephen Fremes, Steven A Fein, Steven P Sedlis, Steven Giovannone, Steven Weitz, Subhash Banerjee, Sudhanva S Hegde, Suellen Hosino, Sulagna Mookherjee, Suman Singh, Sumith Abeygunasekara, Sundeep Mishra, Sunil Kumar Verma, Suresh Kumar, Suryaprakash Narayanappa, Susan K Milbrandt, Susana Silva, Susanna Stevens, Suvarna Kolhe, Suzana Tavares, Suzanne Welsh, T A Kishore, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarek Rashid, Tarun K Mittal, Tauane Bello Duarte, Téodora Dutoiu, Teresa Delgadillo, Terrance Chua, Terrance Welch, Theodoros Kofidis, Thierry Lefevre, Tiago Silva, Timea Boros, Titus Lau, Tiziana Formisano, Tomasz Ciurus, Tomasz Tarchalski, Tracy Tan, Umesh Lingaraj, V K Bahl, V S Narain, Valentina Pellu, Valentine Lobo, Valerie Robesyn, Vandana Yadav, Veerabhadra Gupta, Verghese Mathew, Vicente Miro, Victoria Gumerova, Victoria Hernandez, Vijay Kher, Vijay Kumar, Vikas Makkar, Vikranth Reddy, Viktoria Bulkley, Vinoi George David, Virendra Misra, Virginia Fernández-Figares, Vladimir Ryasniansky, Vojislav L Giga, Wael A Almahmeed, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Wayne Pennachi, Wei Ling Lau, Weibing Xing, Weijing Bian, Wendy L Stewart, Wendy Drewes, Whady Hueb, William Weintraub, Winnie C Sia, Xacobe Flores-Ríos, Xiang Ma, Xiangqiong Gu, Xiaomei Li, Xiaoyi Xu, Xin Fu, Xuemei Li, Xutong Wang, Yanek Pépin-Dubois, Yaron Arbel, Yechen Han, Yiming Lit, Ying Tung Sia, Ying Wang, Yining Yang, Yitong Ma, Yolayfi Peralta, Yves Smets, Yvonne Taul, Zalina Kudzoeva, Zeljko Z Markovic, Zhangsuo Liu, Zhenyu Liu, Zhiming Ye, Zixiang Yu, Zoltan Davidovits, Zvezdana Petronijevic
Subjects: Male, Intention to Treat Analysi, medicine.medical_treatment, Health Status, Myocardial Ischemia, 030204 cardiovascular system & hematology, Coronary Angiography, law.invention, Health Statu, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Odds Ratio, Surveys and Questionnaire, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, medicine.diagnostic_test, General Medicine, Middle Aged, Intention to Treat Analysis, Cardiology, Female, Human, medicine.medical_specialty, Revascularization, Follow-Up Studie, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, cardiovascular diseases, Healthy Lifestyle, Renal Insufficiency, Chronic, Proportional Hazards Models, Aged, Intention-to-treat analysis, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Odds ratio, medicine.disease, Angiography, Exercise Test, Proportional Hazards Model, business, Kidney disease, Follow-Up Studies
Abstract: BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of
Published: 2020

6. Coronary artery bypass grafting or fractional flow reserve-guided percutaneous coronary intervention in diabetic patients with multivessel disease

Author: Frank Van Praet, Carlo Gigante, Filip Casselman, Marc Vanderheyden, Ivan Degriek, Jeroen Sonck, Nina Soto Flores, Bernard De Bruyne, Emanuele Barbato, Jozef Bartunek, Bernard Stockman, M Kodeboina, Giuseppe Di Gioia, Iginio Colaiori, Carlos Collet, Danilo Franco, Di Gioia, G., Flores, N. S., Franco, D., Colaiori, I., Sonck, J., Gigante, C., Kodeboina, M., Bartunek, J., Vanderheyden, M., Van, F., Casselman, F., Degriek, I., Stockman, B., Barbato, E., Collet, C., and De Bruyne, B.
Subjects: Male, medicine.medical_specialty, Cardiac Catheterization, Diabetes mellitu, Time Factors, Bypass grafting, medicine.medical_treatment, Clinical Decision-Making, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Risk Assessment, Coronary artery disease, Percutaneous coronary intervention, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Coronary artery bypa, Coronary physiology, cardiovascular diseases, 030212 general & internal medicine, Coronary Artery Bypass, Aged, business.industry, Coronary Stenosis, Multivessel disease, Middle Aged, medicine.disease, Fractional Flow Reserve, Myocardial, medicine.anatomical_structure, Treatment Outcome, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Artery
Abstract: Background: In diabetic patients with multivessel coronary artery disease, coronary artery bypass grafting (CABG) has shown long-term benefits over percutaneous coronary intervention (PCI). Physiology-guided PCI has shown to improve clinical outcomes in multivessel coronary artery disease, though its impact in diabetic patients has never been investigated. We evaluated long-term clinical outcomes of diabetic patients with multivessel coronary artery disease treated with fractional flow reserve (FFR)–guided PCI compared with CABG. Methods: From 2010 to 2018, 4622 diabetic patients undergoing coronary angiography were screened for inclusion. The inclusion criterion was the presence of at least 2-vessel disease defined as with diameter stenosis ≥50%, in which at least 1 intermediate stenosis (diameter stenosis, 30%–70%) was treated or deferred according to FFR. Inverse probability of treatment weighting analysis was used to account for baseline differences with a contemporary cohort of patients treated with CABG. The primary end point was major adverse cardiovascular and cerebrovascular events, defined as all-cause death, myocardial infarction, revascularization, or stroke. Results: A total of 418 patients were included in the analysis. Among them, 209 patients underwent CABG and 209 FFR-guided PCI. At 5 years, the incidence of major adverse cardiovascular and cerebrovascular events was higher in the FFR-guided PCI versus the CABG group (44.5% versus 31.9%; hazard ratio, 1.60 [95% CI, 1.15–2.22]; P =0.005). No difference was found in the composite of all-cause death, myocardial infarction, or stroke (28.8% versus 27.5%; hazard ratio, 1.05 [95% CI, 0.72–1.53]; P =0.81). Repeat revascularization was more frequent with FFR-guided PCI (24.9% versus 8.2%; hazard ratio, 3.51 [95% CI, 1.93–6.40]; P Conclusions: In diabetic patients with multivessel coronary artery disease, CABG was associated with a lower rate of major adverse cardiovascular and cerebrovascular events compared with FFR-guided PCI, driven by a higher rate of repeat revascularization. At 5-year follow-up, no difference was observed in the composite of all-cause death, myocardial infarction, or stroke between CABG and FFR-guided PCI. Graphic Abstract: A graphic abstract is available for this article.
Published: 2020

7. Triple valve surgery

Author: Daniela Fortuna, Alessandro Leone, Davide Gabbieri, Francesco Nicolini, Florio Pigini, Davide Pacini, Claudio Zussa, Roberto Di Bartolomeo, Rossana De Palma, Reric Investigators, Giovanni Andrea Contini, Leone A., Fortuna D., Gabbieri D., Nicolini F., Contini G.A., Pigini F., Zussa C., Palma R.D., Bartolomeo R.D., and Pacini D.
Subjects: Male, Registrie, medicine.medical_treatment, Heart Valve Diseases, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Retrospective Studie, Medicine, Registries, Hospital Mortality, Coronary Artery Bypass, Aged, 80 and over, Heart Valve Prosthesis Implantation, Mortality rate, Hazard ratio, General Medicine, Middle Aged, Cardiac surgery, Survival Rate, Heart Valve Disease, Treatment Outcome, Italy, Aortic Valve, cardiovascular system, Cardiology, Mitral Valve, Female, Tricuspid Valve, Cardiology and Cardiovascular Medicine, Tricuspid, Human, Adult, Reoperation, medicine.medical_specialty, Triple Valve, Young Adult, 03 medical and health sciences, Mitral, Internal medicine, Valve Replacement, Humans, Survival rate, Proportional Hazards Models, Retrospective Studies, Aged, Mitral valve repair, Proportional hazards model, business.industry, Coronary Artery Bypa, Risk Factor, Aortic, Mitral valve replacement, Odds ratio, 030228 respiratory system, Proportional Hazards Model, business
Abstract: Aims Triple valve surgery (TVS) may still be considered a challenge in cardiac surgery, and is still associated with a not negligible mortality and morbidity. This study analyzed retrospectively patients' data from RERIC (Registro Regionale degli Interventi Cardiochirurgici) registry, to evaluate early and mid-term results of TVS. Methods From April 2002 to December 2013, data from n = 44 211 cardiac surgical procedures were collected from six Cardiac Surgery Departments (RERIC). Two hundred and eighty patients undergoing TVS were identified, including aortic and mitral replacement with tricuspid repair in 211 patients (75.3%), aortic replacement with mitral and tricuspid repair in 64 (22.9%) and triple valve replacement in 5 (1.8%). Univariate and multivariate analyses were performed to identify predictors of overall mortality or adverse outcomes. Results The mean age of the patients was 67.5 ± 12.2. Overall in-hospital mortality rate was 7.9%: in-hospital mortality was 10.9% in mitral valve repair and 6.6% in mitral valve replacement, respectively. Tricuspid valve replacement was associated with the highest mortality rate (40%). Independent predictors of in-hospital mortality were serum creatinine greater than 2 mg/dl [odds ratio (OR) 4.5; P = 0.03], concomitant coronary artery bypass graft (CABG) (OR 3.8; P = 0.01) and previous cardiac surgery (OR 5.1; P = 0.04). Overall cumulative mortality rate at 1, 3 and 5 years was 14.7, 24.1 and 28.9%, respectively. Mitral valve replacement associated with tricuspid valve repair showed better survival rate (hazard ratio 0.1; P = 0.007). Conclusion TVS has demonstrated satisfactory results in terms of in-hospital and mid-term mortality rate. Renal failure, reoperations and concomitant CABG resulted as risk factors for mortality; moreover, we could not demonstrate a mid-term better survival rate of mitral valve repair compared with the replacement.
Published: 2018

8. Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry

Author: Andrea Perrotti, Francesco Onorati, Daniel Reichart, Antonio Salsano, Magnus Dalén, Riccardo Gherli, Juhani Airaksinen, Antonino S. Rubino, Vito G. Ruggieri, Sidney Chocron, Matteo Saccocci, Karl Bounader, Theodor Fischlein, Marisa De Feo, Giuseppe Santarpino, Saverio Nardella, Fausto Biancari, Daniele Maselli, Giovanni Mariscalco, Eeva-Maija Kinnunen, Francesco Nicolini, Giuseppe Faggian, Giuseppe Gatti, Sorosh Khodabandeh, Nicolini, F, Santarpino, G, Gatti, G, Reichart, D, Onorati, F, Faggian, G, Dalén, M, Khodabandeh, S, Fischlein, T, Maselli, D, Nardella, S, Rubino, A, De Feo, M, Salsano A, Gherli, R, Mariscalco, G, Kinnunen, Em, Ruggieri, Vg, Bounader, K, Saccocci, M, Chocron, S, Airaksinen, J, Perrotti, A, and Biancari, F.
Subjects: Male, medicine.medical_specialty, Coronary artery surgery, Glycated Hemoglobin A, HbA1c, endocrine system diseases, Coronary artery bypass, 030204 cardiovascular system & hematology, Diabete, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, CABG, Diabetes, Glycated hemoglobin, Acute Kidney Injury, Aged, Biomarkers, Diabetes Mellitus, Female, Humans, Postoperative Complications, Registries, Surgical Wound Infection, Coronary Artery Bypass, 0302 clinical medicine, Internal medicine, Diabetes mellitus, Coronary artery bypa, Medicine, In patient, 030212 general & internal medicine, Prospective cohort study, ta3126, business.industry, Acute kidney injury, General Medicine, medicine.disease, Surgery, medicine.anatomical_structure, chemistry, business, Cohort study, Artery
Abstract: Background: Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes. Material and methods: Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry. Results: The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value
Published: 2018

9. Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients

Author: Letizia Bacchi Reggiani, Jung-Min Ahn, Mario Sabatino, Marie Claude Morice, Niels Ramsing Holm, Timo H. Mäkikallio, Arie Pieter Kappetein, Raphael Cavalcante, Diego Della Riva, Mattia Romanello, Enno Boudriot, Giuseppe Biondi-Zoccai, Gregg W. Stone, Philippe Généreux, Seung-Jung Park, Joseph F. Sabik, Holger Thiele, Tullio Palmerini, Evald Høj Christiansen, Leif Thuesen, Patrick W. Serruys, Palmerini, Tullio, Serruys, Patrick, Kappetein, Arie Pieter, Genereux, Philippe, Diego Della, Riva, Letizia Bacchi, Reggiani, Christiansen, Evald, Holm, Niels R., Thuesen, Leif, Makikallio, Timo, Morice, Marie Claude, Ahn, Jung-Min, Park, Seung-Jung, Thiele, Holger, Boudriot, Enno, Sabatino, Mario, Mattia, Romanello, Biondi-Zoccai, Giuseppe, Cavalcante, Raphael, Sabik, Joseph F., Stone, Gregg W., Cardiology, and Cardiothoracic Surgery
Subjects: medicine.medical_specialty, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, Revascularization, Global Health, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Postoperative Complications, Randomized controlled trial, law, Internal medicine, Cause of Death, Drug-Eluting Stent, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, Stroke, Survival rate, Randomized Controlled Trials as Topic, business.industry, Coronary Artery Bypa, Incidence, cause of death, coronary artery bypass, coronary artery disease, global health, humans, incidence, percutaneous coronary intervention, postoperative complications, survival rate, drug-eluting stents, randomized controlled trials as topic, cardiology and cardiovascular medicine, Percutaneous coronary intervention, Drug-Eluting Stents, medicine.disease, Surgery, Survival Rate, surgical procedures, operative, Conventional PCI, Cardiology, Postoperative Complication, Cardiology and Cardiovascular Medicine, business, Human
Abstract: Some but not all randomized controlled trials (RCT) have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative to coronary artery bypass grafting (CABG) surgery for the treatment of unprotected left main coronary artery disease (ULMCAD). We therefore aimed to compare the risk of all-cause mortality between PCI and CABG in patients with ULMCAD in a pairwise meta-analysis of RCT. Methods Randomized controlled trials comparing PCI vs CABG for the treatment of ULMCAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. Results Six trials including 4,686 randomized patients were identified. After a median follow-up of 39 months, there were no significant differences between PCI vs CABG in the risk of all-cause mortality (hazard ratio [HR] 0.99, 95% CI 0.76-1.30) or cardiac mortality. However, a significant interaction for cardiac mortality (Pinteraction=.03) was apparent between randomization arm and SYNTAX score, such that the relative risk for mortality tended to be lower with PCI compared with CABG among patients in the lower SYNTAX score tertile, similar in the intermediate tertile, and higher in the upper SYNTAX score tertile. Percutaneous coronary intervention compared with CABG was associated with a similar long-term composite risk of death, myocardial infarction, or stroke (HR 1.06, 95% CI 0.82-1.37), with fewer events within 30 days after PCI offset by fewer events after 30 days with CABG (Pinteraction
Published: 2017

10. Medical therapy or revascularization for patients with chronic total occlusion? A dilemma almost solved

Author: Davide Diana, Giuseppina Novo, Alfredo R. Galassi, Vincenzo Sucato, Galassi A.R., Sucato V., Diana D., and Novo G.
Subjects: medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, business.industry, medicine.medical_treatment, Coronary Artery Bypa, Revascularization, Total occlusion, Surgery, Dilemma, Percutaneous Coronary Intervention, Coronary Occlusion, lcsh:RC666-701, medicine, Myocardial Revascularization, Humans, Coronary Artery Bypass, Cardiology and Cardiovascular Medicine, business, Medical therapy, Human
Abstract: Chronic total occlusion (CTO) of the coronary arteries are relatively common, observed in approximatively 15-25% of patients with coronary artery disease undergoing coronary angiography. The right coronary artery represents the most common CTO vessel, which represents about half of the CTO cases.The CTO prevalence is much higher ( 90%) among patients with prior coronary artery bypass graft (CABG), while a CTO is found in only one tenth of patients referred for ST-elevation myocardial infarction (STEMI)
Published: 2020

11. Long-Term Patency of Coronary Artery Bypass Grafts After Fractional Flow Reserve-Guided Implantation

Author: Emanuele Barbato, Iginio Colaiori, Gabor G. Toth, Stephane Fournier, Bernard De Bruyne, Fournier, S., Toth, G. G., Colaiori, I., De Bruyne, B., and Barbato, E.
Subjects: Coronary angiography, medicine.medical_specialty, coronary stenosi, Cardiac Catheterization, Time Factors, medicine.medical_treatment, Hemodynamics, Bypass grafts, Fractional flow reserve, Coronary Artery Disease, Coronary Angiography, Risk Assessment, atherosclerosi, hemodynamic, Predictive Value of Tests, Risk Factors, Internal medicine, Medicine, Vascular Patency, Humans, Myocardial infarction, Coronary Artery Bypass, Cardiac catheterization, business.industry, coronary artery bypa, Coronary Stenosis, Graft Occlusion, Vascular, medicine.disease, Fractional Flow Reserve, Myocardial, medicine.anatomical_structure, myocardial infarction, Treatment Outcome, Cardiology, Cardiology and Cardiovascular Medicine, business, Artery
Published: 2019

12. Graft patency after FFR-guided versus angiography-guided coronary artery bypass grafting: the GRAFFITI trial

Author: Gabor G. Toth, Martin Mates, Petr Kala, Frank Van Praet, Ivan Degriek, Ruben Ramos, Flavio Ribichini, Zsolt Piroth, Emanuele Barbato, Martin Penicka, Anna Piccoli, Bernard Stockman, Petr Nemec, Bernard De Bruyne, Stephane Fournier, Carlos Van Mieghem, Filip Casselman, Toth, Gabor G, De Bruyne, Bernard, Kala, Petr, Ribichini, Flavio L, Casselman, Filip, Ramos, Ruben, Piroth, Zsolt, Fournier, Stephane, Piccoli, Anna, Van Mieghem, Carlo, Penicka, Martin, Mates, Martin, Nemec, Petr, Van Praet, Frank, Stockman, Bernard, Degriek, Ivan, and Barbato, Emanuele
Subjects: medicine.medical_specialty, Coronary Stenosi, Fractional flow reserve, Coronary Artery Disease, 030204 cardiovascular system & hematology, Anastomosis, Coronary Angiography, 03 medical and health sciences, multiple vessel disease, 0302 clinical medicine, Internal medicine, Clinical endpoint, Humans, Myocardial, Medicine, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, fractional flow reserve, Prospective cohort study, Stroke, medicine.diagnostic_test, business.industry, Coronary Artery Bypa, Coronary Stenosis, medicine.disease, Fractional Flow Reserve, Myocardial, Stenosis, Prospective Studie, Treatment Outcome, Angiography, Cardiology, Cardiology and Cardiovascular Medicine, business, Human
Abstract: Aims The aim of this study was to assess prospectively the clinical benefits of fractional flow reserve (FFR) in guiding coronary artery bypass grafting (CABG). Methods and results GRAFFITI is a single-blinded, prospective, multicentre, randomised controlled trial of FFR-guided versus angiography-guided CABG. We enrolled patients undergoing coronary angiography, having a significantly diseased left anterior descending artery or left main stem and at least one more major coronary artery with intermediate stenosis, assessed by FFR. Surgical strategy was defined based on angiography, blinded to FFR values prior to randomisation. After randomisation, patients were operated on either following the angiography-based strategy (angiography-guided group) or according to FFR, i.e., with an FFR ≤0.80 as cut-off for grafting (FFR-guided group). The primary endpoint was graft patency at 12 months. Between March 2012 and December 2016, 172 patients were randomised either to the angiography-guided group (84 patients) or to the FFR-guided group (88 patients). The patients had a median of three [3; 4] lesions; diameter stenosis was 65% (50%; 80%), FFR was 0.72 (0.50; 0.82). Compared to the angiography-guided group, the FFR-guided group received fewer anastomoses (3 [3; 3] vs 2 [2; 3], respectively; p=0.004). One-year angiographic follow-up showed no difference in overall graft patency (126 [80%] vs 113 [81%], respectively; p=0.885). One-year clinical follow-up, available in 98% of patients, showed no difference in the composite of death, myocardial infarction, target vessel revascularisation and stroke. Conclusions FFR guidance of CABG has no impact on one-year graft patency, but it is associated with a simplified surgical procedure. ClinicalTrials.gov Identifier: NCT01810224.
Published: 2019

13. Noninvasive ventilation after surgical myocardial revascularization for left-ventricular dysfunction: A hypothesis-generating study

Author: Luca Salvatore De Santo, Antonio M. Esquinas, Esquinas, A. M., and De Santo, L. S.
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Myocardial revascularization, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Work of breathing, Ventricular Dysfunction, Left, 0302 clinical medicine, Afterload, Internal medicine, medicine, Myocardial Revascularization, Humans, Lung volumes, Coronary Artery Bypass, Noninvasive Ventilation, business.industry, Coronary Artery Bypa, General Medicine, respiratory system, medicine.anatomical_structure, 030228 respiratory system, Ventricle, Cardiology, Noninvasive ventilation, business, Human
Abstract: To the Editor: Noninvasive ventilation (NIV) affects both the pulmonary and the cardiovascular systems. Indeed, it restores lung volume by opening atelectatic areas, increases alveolar ventilation, and reduces the work of breathing. Moreover, NIV reduces left ventricle afterload and improves
Published: 2019

14. Bleeding in Patients Treated with Ticagrelor or Clopidogrel Before Coronary Artery Bypass Grafting

Author: Marisa De Feo, Juhani Airaksinen, Manne Holm, Daniele Maselli, Marco Zanobini, Stefano Rosato, Sorosh Khodabandeh, Giovanni Mariscalco, Vito G. Ruggieri, Francesco Onorati, Francesco Santini, Giuseppe Santarpino, Fausto Biancari, Riccardo Gherli, Francesco Nicolini, Magnus Dalén, Antonino S. Rubino, Giuseppe Gatti, Eeva-Maija Kinnunen, Daniel Reichart, Andrea Perrotti, Holm, Manne, Biancari, Fausto, Khodabandeh, Sorosh, Gherli, Riccardo, Airaksinen, Juhani, Mariscalco, Giovanni, Gatti, Giuseppe, Reichart, Daniel, Onorati, Francesco, De Feo, Marisa, Santarpino, Giuseppe, Rubino, Antonino S, Maselli, Daniele, Santini, Francesco, Nicolini, Francesco, Zanobini, Marco, Kinnunen, Eeva-Maija, Ruggieri, Vito G, Perrotti, Andrea, Rosato, Stefano, and Dalén, Magnus
Subjects: Male, Pulmonary and Respiratory Medicine, Ticagrelor, medicine.medical_specialty, Postoperative Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, P2Y12, Humans, Medicine, Coronary artery bypa, Prospective Studies, cardiovascular diseases, Coronary Artery Bypass, Prospective cohort study, Aged, Bleeding complication, business.industry, Perioperative, Middle Aged, Clopidogrel, Surgery, Discontinuation, 030228 respiratory system, Preoperative Period, Propensity score matching, Dual antiplatelet therapy, Purinergic P2Y Receptor Antagonists, Platelet aggregation inhibitor, Female, Platelet Aggregation Inhibitors, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background: We evaluated perioperative bleeding after coronary artery bypass grafting (CABG) in patients preoperatively treated with ticagrelor or clopidogrel, stratified by discontinuation of these P2Y₁₂ inhibitors. Methods: All patients from the prospective, European Multicenter Registry on Coronary Artery Bypass Grafting (E-CABG) treated with ticagrelor or clopidogrel undergoing isolated primary CABG were eligible. The primary outcome measure was severe or massive bleeding defined according to the Universal Definition of Perioperative Bleeding, stratified by P2Y₁₂ inhibitor discontinuation. Secondary outcome measures included four additional definitions of major bleeding. Propensity score matching was performed to adjust for differences in preoperative and perioperative covariates. Results: Of 2,311 patients who were included, 1,293 (55.9%) received clopidogrel and 1,018 (44.1%) ticagrelor preoperatively. Mean time between discontinuation and the operation was 4.5 ± 3.2 days for clopidogrel and 4.9 ± 3.0 days for ticagrelor. In the propensity score–matched cohort, ticagrelor-treated patients had a higher incidence of major bleeding according to Universal Definition of Perioperative Bleeding when ticagrelor was discontinued 0 to 2 days compared with 3 days before the operation (16.0% vs 2.7%, p = 0.003). Clopidogrel-treated patients had a higher incidence of major bleeding according to the Universal Definition of Perioperative Bleeding when clopidogrel was discontinued 0 to 3 days compared with 4 to 5 days before the operation (15.6% vs 8.3%, p = 0.031). Conclusions: In patients receiving ticagrelor 2 days before CABG and in those receiving clopidogrel 3 days before CABG, there was an increased rate of severe bleeding. Postponing nonemergent CABG for at least 3 days after discontinuation of ticagrelor and 4 days after clopidogrel should be considered.
Published: 2019

15. Stopping vs. Continuing Aspirin before Coronary Artery Surgery

Author: Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, Wallace S, ATACAS Investigators of the ANZCA Clinical Trials Network, Landoni G, Myles, P, Smith, Ja, Forbes, A, Silbert, B, Jayarajah, M, Painter, T, Cooper, Dj, Marasco, S, Mcneil, J, Bussières, J, Wallace, S, ATACAS Investigators of the ANZCA Clinical Trials, Network, and Landoni, G
Subjects: Male, medicine.medical_specialty, Postoperative Hemorrhage, 030204 cardiovascular system & hematology, Placebo, Coronary artery disease, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Double-Blind Method, Preoperative Care, medicine, Humans, Blood Transfusion, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, Stroke, Aged, Aspirin, business.industry, Platelet Aggregation Inhibitor, Coronary Artery Bypa, Medicine (all), Thrombosis, General Medicine, Perioperative, Length of Stay, Middle Aged, medicine.disease, Surgery, Bypass surgery, Thrombosi, Commentary, Female, Postoperative Complication, business, Platelet Aggregation Inhibitors, Human, medicine.drug
Abstract: BACKGROUND Most patients with coronary artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing surgery, but it is unclear whether aspirin should be stopped before coronary artery surgery. METHODS We used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo coronary artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. RESULTS Among 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo. A primary outcome event occurred in 202 patients in the aspirin group (19.3%) and in 215 patients in the placebo group (20.4%) (relative risk, 0.94; 95% confidence interval, 0.80 to 1.12; P = 0.55). Major hemorrhage leading to reoperation occurred in 1.8% of patients in the aspirin group and in 2.1% of patients in the placebo group (P = 0.75), and cardiac tamponade occurred at rates of 1.1% and 0.4%, respectively (P = 0.08). CONCLUSIONS Among patients undergoing coronary artery surgery, the administration of preoperative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding than that with placebo. (Funded by the Australian National Health and Medical Research Council and others; Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639.).
Published: 2016

16. D-dimer is associated with arterial and venous coronary artery bypass graft occlusion

Author: Parolari, A, Cavallotti, L, Andreini, D, Myasoedova, V, Banfi, C, Camera, M, Poggio, P, Barili, F, Pontone, G, Mussoni, L, Centenaro, C, Alamanni, F, Tremoli, E, Zanobini, M, Roberto, M, Porqueddu, M, Naliato, M, Kassem, S, Mushtaq, S, Bertella, E, Pepi, M, Annoni, A, Formenti, A, Brambilla, M, Ghilardi, S, Brioschi, M, Barbieri, S, Parolari A., Cavallotti L., Andreini D., Myasoedova V., Banfi C., Camera M., Poggio P., Barili F., Pontone G., Mussoni L., Centenaro C., Alamanni F., Tremoli E., Zanobini M., Roberto M., Porqueddu M., Naliato M., Kassem S., Mushtaq S., Bertella E., Pepi M., Annoni A., Formenti A., Brambilla M., Ghilardi S., Brioschi M., Barbieri S., Parolari, A, Cavallotti, L, Andreini, D, Myasoedova, V, Banfi, C, Camera, M, Poggio, P, Barili, F, Pontone, G, Mussoni, L, Centenaro, C, Alamanni, F, Tremoli, E, Zanobini, M, Roberto, M, Porqueddu, M, Naliato, M, Kassem, S, Mushtaq, S, Bertella, E, Pepi, M, Annoni, A, Formenti, A, Brambilla, M, Ghilardi, S, Brioschi, M, Barbieri, S, Parolari A., Cavallotti L., Andreini D., Myasoedova V., Banfi C., Camera M., Poggio P., Barili F., Pontone G., Mussoni L., Centenaro C., Alamanni F., Tremoli E., Zanobini M., Roberto M., Porqueddu M., Naliato M., Kassem S., Mushtaq S., Bertella E., Pepi M., Annoni A., Formenti A., Brambilla M., Ghilardi S., Brioschi M., and Barbieri S.
Abstract: Objective In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusion at 18 months to identify a signature for graft occlusion. Methods A total of 330 patients undergoing primary elective coronary artery bypass grafting were enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiography at 18 months follow-up, and 179 patients underwent coronary computed tomography angiography 18 ± 2 months postoperatively. Results There were 46 of 503 (9.1%) occluded grafts; of these, 29 (63%) were venous and 17 (37%) were arterial grafts; overall, 43 of 179 patients (24%) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusion identified that lower D-dimer levels at baseline (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.36-4.89; P =.00) and total protein content at discharge (OR, 1.09; 95% CI, 1.01-1.19; P =.028) were related to overall graft occlusion at follow-up, along with an arterial graft other than the left internal thoracic artery (OR, 2.92; 95% CI, 1.24-6.9; P =.078); moreover, a venous graft emerged was possibly associated with graft occlusion (OR, 1.51; 95% CI, 0.95-2.39; P =.078). By separately analyzing saphenous vein and arterial grafts, D-dimer levels (OR, 2.67; 95% CI, 1.15-6.2; P =.022 and OR, 2.5; 95% CI, 1.01-7.0; P =.05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusion at follow-up. Conclusions We identified D-dimer as a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graft failure and identify new molecular targets to prevent this complication.
Published: 2018

17. CABG for patients with heart dysfunction: When and why to refuse surgery

Author: Bruno, Piergiorgio, Iafrancesco, Mauro, Massetti, Massimo, Bruno, Piergiorgio (ORCID:0000-0002-1075-5808), Massetti, Massimo (ORCID:0000-0002-7100-8478), Bruno, Piergiorgio, Iafrancesco, Mauro, Massetti, Massimo, Bruno, Piergiorgio (ORCID:0000-0002-1075-5808), and Massetti, Massimo (ORCID:0000-0002-7100-8478)
Abstract: Surgical myocardial revascularization in patients with reduced left ventricular function has been a matter of debate for decades. A recently-published 10-year extension follow-up of the STICH trial has conclusively demonstrated the benefit of surgical myocardial revascularization in patients with significant coronary artery disease and low left ventricular ejection fraction. However, patient selection for surgery remains challenging, and so does the decision to perform percutaneous rather than surgical revascularization in this class of patients. New evidence helped to clarify the role of preoperative patients' characteristics as risk factors for surgery and to identify those patients who may benefit the most from surgery. Focus of this review is to review epidemiology and results of observational and investigational studies on revascularization in patients with reduced left ventricular function with a particular emphasis on relative indication of coronary artery bypass grafting and percutaneous coronary intervention.
Published: 2018

18. 'protected' PCI: Time to act

Author: Burzotta, Francesco, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Crea, Filippo (ORCID:0000-0001-9404-8846), Burzotta, Francesco, Crea, Filippo, Burzotta, Francesco (ORCID:0000-0002-6569-9401), and Crea, Filippo (ORCID:0000-0001-9404-8846)
Abstract: N/A
Published: 2018

19. The Radial Artery for Percutaneous Coronary Procedures or Surgery?

Author: Gaudino, Mario Fulvio Luigi, Burzotta, Francesco, Bakaeen, Faisal, Bertrand, Olivier, Crea, Filippo, Di Franco, Antonino, Fremes, Stephen, Kiemeneij, Ferdinand, Louvard, Yve, Rao, Sunil V, Schwann, Thomas A, Tatoulis, Jame, Tranbaugh, Robert F, Trani, Carlo, Valgimigli, Marco, Vranckx, Pascal, Taggart, David P, Gaudino, Mario (ORCID:0000-0001-7529-438X), Burzotta, Francesco (ORCID:0000-0002-6569-9401), Crea, Filippo (ORCID:0000-0001-9404-8846), Trani, Carlo (ORCID:0000-0001-9777-013X), Gaudino, Mario Fulvio Luigi, Burzotta, Francesco, Bakaeen, Faisal, Bertrand, Olivier, Crea, Filippo, Di Franco, Antonino, Fremes, Stephen, Kiemeneij, Ferdinand, Louvard, Yve, Rao, Sunil V, Schwann, Thomas A, Tatoulis, Jame, Tranbaugh, Robert F, Trani, Carlo, Valgimigli, Marco, Vranckx, Pascal, Taggart, David P, Gaudino, Mario (ORCID:0000-0001-7529-438X), Burzotta, Francesco (ORCID:0000-0002-6569-9401), Crea, Filippo (ORCID:0000-0001-9404-8846), and Trani, Carlo (ORCID:0000-0001-9777-013X)
Abstract: This article summarizes the current research on the benefits of using the transradial approach for percutaneous procedures and the radial artery as a conduit for coronary artery bypass surgery. Based on the available evidence, the authors provide recommendations for the use of the radial artery in patients undergoing percutaneous or surgical coronary procedures.
Published: 2018

20. Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery

Author: Gabor G. Toth, Panagiotis Xaplanteris, Nils P. Johnson, Eric Wyffels, Emanuele Barbato, Teresa Strisciuglio, Jozef Bartunek, Stephane Fournier, Bernard De Bruyne, Filip Casselman, Marc Vanderheyden, Ivan Degrieck, Frank Van Praet, Anastasios Milkas, Giovanni Ciccarelli, Bernard Stockman, Fournier, Stephane, Toth, Gabor G, De Bruyne, Bernard, Johnson, Nils P, Ciccarelli, Giovanni, Xaplanteris, Panagioti, Milkas, Anastasio, Strisciuglio, Teresa, Bartunek, Jozef, Vanderheyden, Marc, Wyffels, Eric, Casselman, Filip, Van Praet, Frank, Stockman, Bernard, Degrieck, Ivan, and Barbato, Emanuele
Subjects: Male, medicine.medical_specialty, Cardiac Catheterization, coronary stenosi, Time Factors, Fractional flow reserve, Coronary stenosis, 030204 cardiovascular system & hematology, Anastomosis, Coronary Angiography, Risk Assessment, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Medicine, Humans, angiography, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, fractional flow reserve, Vascular Patency, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, coronary artery bypa, Coronary Stenosis, Graft Occlusion, Vascular, Middle Aged, medicine.disease, Coronary Vessels, Surgery, Fractional Flow Reserve, Myocardial, medicine.anatomical_structure, Treatment Outcome, myocardial infarction, Angiography, Female, Cardiology and Cardiovascular Medicine, business, coronary artery disease, Artery
Abstract: Background— Fractional flow reserve (FFR)-guided coronary artery bypass graft (CABG) surgery has been associated with lower number of graft anastomoses, lower rate of on-pump surgery, and higher graft patency rate as compared with angiography-guided CABG surgery. However, no clinical benefit has been reported to date. Methods and Results— Consecutive patients (n=627) treated by CABG between 2006 and 2010 were retrospectively included. In 198 patients, at least 1 stenosis was grafted according to FFR (FFR-guided group), whereas in 429 patients all stenoses were grafted based on angiography (angiography-guided group). The 2 coprimary end points were overall death or myocardial infarction and major adverse cardiovascular events (composite of overall death, myocardial infarction, and target vessel revascularization) up to 6-year follow-up. In the FFR-guided group, patients were significantly younger (66 [57–73] versus 70 [63–76]; P P =0.008), and less often diabetic (21% versus 30%; P =0.023). Clinical follow-up (median, 85 [66–104] months) was analyzed in 396 patients after 1:1 propensity-score matching for these 3 variables. The rate of overall death or myocardial infarction was significantly lower in the FFR-guided (n=31 [16%] versus n=49 [25%]; hazard ratio, 0.59 [95% confidence interval, 0.38–0.93]; P =0.020) as compared with the angiography-guided group. Major adverse cardiovascular events rate was also numerically lower in the FFR-guided than in the angiography-guided group (n=42 [21%] versus n=52 [26%]; hazard ratio, 0.77 [95% confidence interval, 0.51–1.16]; P =0.21). Conclusions— FFR-guided CABG is associated with a significant reduction in the rate of overall death or myocardial infarction at 6-year follow-up as compared with angiography-guided CABG.
Published: 2018

21. Prognostic Impact of Prolonged Cross-Clamp Time in Coronary Artery Bypass Grafting

Author: Riccardo Gherli, Giuseppe Santarpino, Francesco Onorati, Jean Philippe Verhoye, Matteo Saccocci, Karl Bounader, Fausto Biancari, Giuseppe Gatti, Daniel Reichart, Marisa De Feo, Sidney Chocron, Giuseppe Faggian, Antonio Salsano, Vito G. Ruggieri, Peter Svenarud, Tuomas Tauriainen, Magnus Dalén, Antonino S. Rubino, Tiziano Gherli, Andrea Perrotti, Giovanni Mariscalco, Francesco Nicolini, Daniele Maselli, Juhani Airaksinen, Ruggieri, Vito G., Bounader, Karl, Verhoye, Jean Philippe, Onorati, Francesco, Rubino, Antonino S., Gatti, Giuseppe, Tauriainen, Tuoma, De Feo, Marisa, Reichart, Daniel, Dalã©n, Magnu, Svenarud, Peter, Faggian, Giuseppe, Santarpino, Giuseppe, Maselli, Daniele, Gherli, Riccardo, Mariscalco, Giovanni, Salsano, Antonio, Nicolini, Francesco, Gherli, Tiziano, Saccocci, Matteo, Airaksinen, Juhani K. E., Chocron, Sidney, Perrotti, Andrea, and Biancari, Fausto
Subjects: Male, Inotrope, Time Factors, medicine.medical_treatment, Myocardial Ischemia, Coronary artery bypass, 030204 cardiovascular system & hematology, Myocardial ischaemia, law.invention, Postoperative Complications, 0302 clinical medicine, Risk Factors, law, Hospital Mortality, Prospective Studies, CABG, Incidence, Atrial fibrillation, Cardiac surgery, Prognosis, Intensive care unit, Europe, Survival Rate, Treatment Outcome, medicine.anatomical_structure, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cross clamp, Cross-clamping, Pulmonary and Respiratory Medicine, Artery, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, Extracorporeal membrane oxygenation, Humans, Coronary artery bypa, Propensity Score, Adverse effect, Aged, business.industry, ta3121, medicine.disease, CABG, Cardiac surgery, Coronary artery bypass, Cross clamp, Cross-clamping, Myocardial ischaemia, 030228 respiratory system, Propensity score matching, business, Follow-Up Studies
Abstract: Background: The prognostic impact of cross-clamp time (XCT) in patients undergoing isolated coronary artery bypass grafting (CABG) has not been thoroughly investigated. Material and Methods: 2957 patients who underwent on-pump isolated CABG from the prospective multicentre E-CABG study were the subjects of this analysis. Results: The mean XCT in this series was 58 ± 25 minutes Cross-clamp time was >60 minutes in 1134 patients (38.3%), >75 minutes in 619 patients (20.9%) and >90 minutes in 296 patients (10.0%). Multivariate analysis showed that XCT was an independent predictor of 30-day mortality (p < 0.0001, OR 1.027, 95%CI 1.015–1.039) along with age (p < 0.0001), female gender (p = 0.001), pulmonary disease (p = 0.001), poor mobility (p = 0.002), urgency status (p = 0.007), critical preoperative status (p = 0.002) and participating centres (p = 0.015). Adjusted risk of 30-day mortality was highest for XCT >75 minutes (2.9% vs. 1.7%, p = 0.002, OR 3.479, 95%CI 1.609–7.520). Analysis of 428 propensity score matched pairs showed that XCT >75 minutes was associated with significantly increased risk of early mortality, prolonged use of inotropes, postoperative use of intra-aortic balloon pump, use of extracorporeal membrane oxygenation, atrial fibrillation, prolonged stay in the intensive care unit and of composite major adverse events. Conclusions: Isolated CABG is currently performed with prolonged XCT in a significant number of patients and this seems to be a determinant of poor early outcome.
Published: 2018

22. Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients

Author: Palmerini T., Della Riva D., Biondi-Zoccai G., Leon M. B., Serruys P. W., Smits P. C., von Birgelen C., Ben-Yehuda O., Genereux P., Bruno A. G., Jenkins P., Stone G. W., Palmerini T., Della Riva D., Biondi-Zoccai G., Leon M.B., Serruys P.W., Smits P.C., von Birgelen C., Ben-Yehuda O., Genereux P., Bruno A.G., Jenkins P., and Stone G.W.
Subjects: Male, Time Factor, Coronary Artery Bypa, Risk Factor, Myocardial Infarction, Coronary Artery Disease, Middle Aged, mortality, Percutaneous Coronary Intervention, Treatment Outcome, Coronary Restenosi, Cause of Death, Retreatment, Stent, target lesion revascularization, Female, restenosi, Aged, Human, Randomized Controlled Trials as Topic
Abstract: Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). Background: Restenosis requiring TLR after PCI is generally considered a benign event. Methods: The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. Results: The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non–procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001). Conclusions: Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.
Published: 2018

23. D-dimer is associated with arterial and venous coronary artery bypass graft occlusion

Author: Alessandro Parolari, Maura Brioschi, Saima Mushtaq, Marco Zanobini, Elena Tremoli, Marina Camera, Gianluca Pontone, Fabio Barili, Marta Brambilla, Massimo Porqueddu, Daniele Andreini, Paolo Poggio, Moreno Naliato, Laura Cavallotti, Cristina Banfi, Mauro Pepi, Samer Kassem, Silvia S. Barbieri, Luciana Mussoni, Veronika A. Myasoedova, Andrea Annoni, Chiara Centenaro, Maurizio Roberto, Alberto Formenti, Francesco Alamanni, Stefania Ghilardi, Erika Bertella, Parolari, A, Cavallotti, L, Andreini, D, Myasoedova, V, Banfi, C, Camera, M, Poggio, P, Barili, F, Pontone, G, Mussoni, L, Centenaro, C, Alamanni, F, Tremoli, E, Zanobini, M, Roberto, M, Porqueddu, M, Naliato, M, Kassem, S, Mushtaq, S, Bertella, E, Pepi, M, Annoni, A, Formenti, A, Brambilla, M, Ghilardi, S, Brioschi, M, and Barbieri, S
Subjects: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Computed Tomography Angiography, 030204 cardiovascular system & hematology, Coronary Angiography, Risk Assessment, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Occlusion, D-dimer, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Postoperative Period, Prospective Studies, Coronary Artery Bypass, Prospective cohort study, Vein, Vascular Patency, Computed tomography angiography, Aged, medicine.diagnostic_test, business.industry, coronary artery bypa, Graft Occlusion, Vascular, Odds ratio, Middle Aged, graft patency, Surgery, medicine.anatomical_structure, Italy, Elective Surgical Procedures, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Complication, Biomarkers, Artery, Follow-Up Studies
Abstract: Objective In this observational prospective study, we assessed the role of clinical variables and circulating biomarkers in graft occlusion at 18 months to identify a signature for graft occlusion. Methods A total of 330 patients undergoing primary elective coronary artery bypass grafting were enrolled. Blood collection for biomarker assessment was performed before surgery and discharge. Patients were then scheduled to undergo coronary computed tomography angiography at 18 months follow-up, and 179 patients underwent coronary computed tomography angiography 18 ± 2 months postoperatively. Results There were 46 of 503 (9.1%) occluded grafts; of these, 29 (63%) were venous and 17 (37%) were arterial grafts; overall, 43 of 179 patients (24%) had at least 1 occluded graft. Logistic mixed effects model assessing independent factors associated with graft occlusion identified that lower D-dimer levels at baseline (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.36-4.89; P = .00) and total protein content at discharge (OR, 1.09; 95% CI, 1.01-1.19; P = .028) were related to overall graft occlusion at follow-up, along with an arterial graft other than the left internal thoracic artery (OR, 2.92; 95% CI, 1.24-6.9; P = .078); moreover, a venous graft emerged was possibly associated with graft occlusion (OR, 1.51; 95% CI, 0.95-2.39; P = .078). By separately analyzing saphenous vein and arterial grafts, D-dimer levels (OR, 2.67; 95% CI, 1.15-6.2; P = .022 and OR, 2.5; 95% CI, 1.01-7.0; P = .05 for venous and arterial graft, respectively) were still associated with arterial and venous graft occlusion at follow-up. Conclusions We identified D-dimer as a biomarker associated with arterial and venous grafts occlusion. This may help stratify patients at risk of graft failure and identify new molecular targets to prevent this complication.
Published: 2018

24. Everolimus-eluting stents or bypass surgery for left main coronary artery disease

Author: Stone, Gw, Sabik, Jf, Serruys, Pw, Simonton, Ca, Généreux, P, Puskas, J, Kandzari, De, Morice, Mc, Lembo, N, Brown WM 3rd, Taggart, Dp, Banning, A, Merkely, B, Horkay, F, Boonstra, Pw, van Boven AJ, Ungi, I, Bogáts, G, Mansour, S, Noiseux, N, Sabaté, M, Pomar, J, Hickey, M, Gershlick, A, Buszman, P, Bochenek, A, Schampaert, E, Pagé, P, Dressler, O, Kosmidou, I, Mehran, R, Pocock, Sj, Kappetein, Ap, van Es GA, Leon, Mb, Gersh, B, Chaturvedi, S, Kint, Pp, Valgimigli, M, Colombo, A, Costa, M, Di Mario, C, Ellis, S, Fajadet, J, Fearon, W, Kereiakes, D, Makkar, R, Mintz, Gs, Moses, Jw, Teirstein, P, Ruel, M, Sergeant, P, Mack, M, Fontana, G, Mohr, Fw, Nataf, P, Smith, C, Boden, B, Fox, K, Maron, D, Steg, G, Blackstone, E, Juni, P, Parise, H, Wallentin, L, Bertrand, M, Krucoff, M, Turina, M, Ståhle, E, Tijssen, J, Brill, D, Atkins, C, Applegate, B, Argenziano, M, Faly, Rc, Dauerman, H, Davidson, C, Griffith, B, Reisman, M, Rizik, D, Sakwa, M, Shemin, R, Romano, M, Hamm, C, Gummert, J, Tamburino, C, Alfieri, O, Savina, C, de Bruyne, B, Machado, Fp, Uva, S, Moccetti, T, Siclari, F, Hildick Smith, D, Szekely, L, Erglis, A, Stradins, P, Abizaid, A, Bento Sousa LC, Belardi, J, Navia, D, Park, Sj, Lee, Jw, Meredith, I, Smith, J, Yehuda, Ob, Schneijdenberg, R, Ronden, J, Jonk, J, Jonkman, A, van Remortel, E, de Zwart, I, Elshout, L, de Vries, T, Andreae, R, Tol van, J, Teurlings, E, Balachandran, S, Breazna, A, Jenkins, P, Mcandrew, T, Marx, So, Connolly, Mw, Hong, Mk, Weinberger, J, Wong, Sc, Dizon, J, Biviano, A, Morrow, J, Wang, D, Corral, M, Alfonso, M, Sanchez, R, Wright, D, Djurkovic, C, Lustre, M, Jankovic, I, Sanidas, E, Lasalle, L, Maehara, A, Matsumura, M, Sun, E, Iacono, S, Greenberg, T, Jacobson, J, Pullano, A, Gacki, M, Liu, S, Cohen, Dj, Magnuson, E, Baron, Sj, Wang, K, Traylor, K, Worthley, S, Stuklis, R, Barbato, E, Stockman, B, Dubois, C, Meuris, B, Vrolix, M, Dion, R, Bento de Souza LC, Costantini, C, Woitowicz, V, Hueb, W, Stolf, N, Beydoun, H, Baskett, R, Curtis, M, Kieser, T, Doucet, S, Pellerin, M, Hamburger, J, Cook, R, Kutryk, M, Peterson, M, Madan, M, Fremes, S, Mehta, S, Cybulsky, I, Prabhakar, M, Peniston, C, Welsh, R, Macarthur, R, Berland, J, Bessou, Jp, Carrié, D, Glock, Y, Darremont, O, Deville, C, Grimaud, Jp, Soula, P, Lefèvre, T, Maupas, E, Durrleman, N, Silvestri, M, Houel, R, Pratt, A, Francis, J, Van Belle, E, Vicentelli, A, Luchner, A, Hilker, M, Endemann, Dh, Felix, S, Wollert, Hg, Walther, T, Erbel, R, Jacob, H, Kahlert, P, Kupatt, C, Näbauer, M, Schmitz, C, Scholtz, W, Börgermann, J, Schuler, G, Borger, M, Davierwala, P, Fontos, G, Székely, L, Bedogni, F, Panisi, P, Berti, S, Glauber, M, Marzocchi, A, Di Bartolomeo, R, Merlo, M, Guagliumi, G, Fenili, F, Napodano, M, Gerosa, G, Ribichini, F, Faggian, Giuseppe, Saccà, S, Giacomin, A, Mignosa, C, Tumscitz, C, Savini, C, Van Mieghem, N, von Birgelen, C, Grandjean, J, Kubica, J, Anisimowicz, L, Zmudka, K, Sadowski, J, Hernández García, J, Such, M, Macaya, C, Rodríguez Hernández JE, Maroto, L, Serra, A, Padro, J, Tenas, Ms, De Souza, A, Egred, M, Clark, S, Trivedi, U, Jain, A, Uppal, R, Redwood, S, Young, C, Stables, Rh, Pullan, M, Uren, N, Pessotto, R, Abu Fadel, M, Peyton, M, Allaqaband, S, O’Hair, D, Bachinsky, W, Mumtaz, M, Blankenship, J, Casale, A, Brott, B, Davies, J, Brown, D, Cannon, L, Talbott, J, Chang, G, Macheers, S, Choi, J, Henry, C, Cutlip, D, Khabbaz, K, Das, G, Liao, K, Diver, D, Thayer, J, Dobies, D, Fliegner, K, Fischbein, M, Feldman, T, Pearson, P, Foster, M, Briggs, R, Giugliano, G, Engelman, D, Gordon, P, Ehsan, A, Grantham, J, Allen, K, Grodin, J, Jessen, M, Gruberg, L, Taylor JR Jr, Gupta, S, Hermiller J., Jr, Heimansohn, D, Iwaoka, R, Chan, B, Kander, Nh, Duff, S, Brown, W, Karmpaliotis, D, Kini, A, Filsoufi, F, Kong, D, Lin, S, Kutcher, M, Kincaid, E, Leya, F, Bakhos, M, Liberman, H, Halkos, M, Lips, D, Eales, F, Mahoney, P, Rich, J, Barreiro, C, Cheng, W, Metzger, C, Greenfield, T, Moses, J, Palacios, I, Macgillivray, T, Perin, E, Del Prete, J, Pompili, V, Kilic, A, Ragosta, M, Kron, I, Rashid, J, Mueller, D, Riley, R, Reimers, C, Patel, N, Resar, J, Shah, A, Schneider, J, Landvater, L, Reardon, M, Shavelle, D, Baker, C, Singh, J, Maniar, H, Wei, L, Strain, J, Zapolanski, A, Taheri, H, Ad, N, Tannenbaum, M, Prabhakar, G, Waksman, R, Corso, P, Wang, J, Fiocco, M, Wilson, Bh, Steigel, Rm, Chadwick, S, Zidar, F, Oswalt, J., Stone, Gregg W., Sabik, Joseph F., Serruys, Patrick W., Simonton, Charles A., Généreux, Philippe, Puskas, John, Kandzari, David E., Morice, Marie Claude, Lembo, Nichola, Brown, W. Morri, Taggart, David P., Banning, Adrian, Merkely, Béla, Horkay, Ferenc, Boonstra, Piet W., Van Boven, Ad J., Ungi, Imre, Bogáts, Gabor, Mansour, Samer, Noiseux, Nicola, Sabaté, Manel, Pomar, José, Hickey, Mark, Gershlick, Anthony, Buszman, Pawel, Bochenek, Andrzej, Schampaert, Erick, Pagé, Pierre, Dressler, Ovidiu, Kosmidou, Ioanna, Mehran, Roxana, Pocock, Stuart J., Kappetein, A. Pieter, for the EXCEL Trial Investigators:, [. . ., Antonio, Marzocchi, DI BARTOLOMEO, Roberto, ], . ., and Cardiothoracic Surgery
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Randomized controlled trial, law, Internal medicine, medicine, Clinical endpoint, Drug-Eluting Stent, Humans, Everolimus, 030212 general & internal medicine, cardiovascular diseases, Coronary Artery Bypass, Aged, Female, Middle Aged, Drug-Eluting Stents, business.industry, Coronary Artery Bypa, Medicine (all), Percutaneous coronary intervention, General Medicine, medicine.disease, Surgery, Cardiac surgery, Everolimu, surgical procedures, operative, Bypass surgery, Conventional PCI, Cardiology, business, medicine.drug, Human
Abstract: BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P
Published: 2017

25. Outcome in Patients Having Salvage Coronary Artery Bypass Grafting

Author: Sidney Chocron, Ciro Bancone, Giovanni Mariscalco, Giuseppe Santarpino, Eeva-Maija Kinnunen, Vito G. Ruggieri, Francesco Onorati, Angelo M. Dell’Aquila, Aniello Pappalardo, Antonino S. Rubino, Cesare Beghi, Francesco Musumeci, Giuseppe Faggian, Marisa De Feo, Fausto Biancari, Giuseppe Gatti, Andrea Perrotti, Riccardo Gherli, Karl Bounader, Carmelo Mignosa, Magnus Dalén, Theodor Fischlein, Peter Svenarud, Santarpino, Giuseppe, Ruggieri, Vito G., Mariscalco, Giovanni, Bounader, Karl, Beghi, Cesare, Fischlein, Theodor, Onorati, Francesco, Faggian, Giuseppe, Gatti, Giuseppe, Pappalardo, Aniello, DE FEO, Marisa, Bancone, Ciro, Perrotti, Andrea, Chocron, Sidney, Dalen, Magnu, Svenarud, Peter, Rubino, Antonino S., Mignosa, Carmelo, Gherli, Riccardo, Musumeci, Francesco, Dell'Aquila, Angelo M., Kinnunen, Eeva Maija, and Biancari, Fausto
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Shock, Cardiogenic, Salvage therapy, Extracorporeal Membrane Oxygenation, Retrospective Studie, Internal medicine, medicine, Extracorporeal membrane oxygenation, Humans, Hospital Mortality, Cardiopulmonary resuscitation, Coronary Artery Bypass, Survival rate, Aged, Retrospective Studies, Salvage Therapy, business.industry, Coronary Artery Bypa, Cardiogenic shock, Percutaneous coronary intervention, EuroSCORE, Length of Stay, Middle Aged, medicine.disease, Cardiac surgery, Surgery, Europe, Survival Rate, Aged, Coronary Artery Bypass, Europe, Extracorporeal Membrane Oxygenation, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Salvage Therapy, Shock Cardiogenic, Survival Rate, Treatment Outcome, Treatment Outcome, surgical procedures, operative, Cardiology, Shock Cardiogenic, Female, Cardiology and Cardiovascular Medicine, business, Human
Abstract: Salvage coronary artery bypass grafting (CABG) is often performed for cardiogenic shock on compassionate basis without clinical data justifying this aggressive approach. The aim of this study was to analyze early and intermediate outcomes after salvage CABG. We retrospectively reviewed the data of 85 patients who underwent salvage CABG at 11 European cardiac surgery centers. Salvage CABG was defined according to the EuroSCORE criteria, that is, a procedure performed in patients requiring cardiopulmonary resuscitation (external cardiac massage) en route to the operating theater or before induction of anesthesia. A percutaneous coronary intervention procedure preceded salvage CABG in 55 patients (64.7%). Thirty patients (35.3%) died during the inhospital stay. The mean EuroSCORE II was 32.0% and the observed-to-expected ratio was 1.08. Salvage CABG was associated with high rates of postoperative stroke (9.4%), resternotomy for bleeding (23.5%), resternotomy for hemodynamic instability (15.3%), dialysis (18.8%), severe gastrointestinal complications (12.9%), and deep sternal wound infection (10.6%). Survival at 1, 3, and 5 years was 58.6%, 49.8%, and 40.9%, respectively. Twenty patients (23.5%) were postoperatively treated with extracorporeal membrane oxygenation (ECMO). The rates of adverse events after ECMO were particularly high (stroke 40%, resternotomy for bleeding 60%, dialysis 35%, gastrointestinal complications 30%, and deep sternal wound infection 30%). Of patients treated with ECMO, 8 (40%) survived to discharge, and 1-year survival was 29.2%. Salvage CABG is associated with high risk of immediate mortality and severe adverse events. However, the observed immediate and intermediate outcome justify coronary surgery in these critically ill patients. A number of these patients are currently treated by ECMO, and its results are encouraging.
Published: 2015

26. Stable coronary artery disease: revascularisation and invasive strategies

Author: Roxana Mehran, Stephan Windecker, Raffaele Piccolo, Gennaro Giustino, Piccolo, Raffaele, Giustino, Gennaro, Mehran, Roxana, and Windecker, Stephan
Subjects: medicine.medical_specialty, medicine.medical_treatment, Coronary Artery Disease, Fractional flow reserve, Coronary artery disease, Percutaneous Coronary Intervention, Internal medicine, Intravascular ultrasound, Drug-Eluting Stent, Myocardial Revascularization, medicine, Humans, cardiovascular diseases, Myocardial infarction, Coronary Artery Bypass, 610 Medicine & health, Postoperative Care, Cardiac Imaging Technique, Evidence-Based Medicine, medicine.diagnostic_test, business.industry, Coronary Artery Bypa, Platelet Aggregation Inhibitor, Medicine (all), Percutaneous coronary intervention, Drug-Eluting Stents, General Medicine, medicine.disease, Surgery, Fractional Flow Reserve, Myocardial, Cardiac Imaging Techniques, Treatment Outcome, surgical procedures, operative, medicine.anatomical_structure, Conventional PCI, Cardiology, Platelet aggregation inhibitor, business, Platelet Aggregation Inhibitors, Human, Artery
Abstract: Stable coronary artery disease is the most common clinical manifestation of ischaemic heart disease and a leading cause of mortality worldwide. Myocardial revascularisation is a mainstay in the treatment of symptomatic patients or those with ischaemia-producing coronary lesions, and reduces ischaemia to a greater extent than medical treatment. Documentation of ischaemia and plaque burden is fundamental in the risk stratification of patients with stable coronary artery disease, and several invasive and non-invasive techniques are available (eg, fractional flow reserve or intravascular ultrasound) or being validated (eg, instantaneous wave-free ratio and optical coherence tomography). The use of new-generation drug-eluting stents and arterial conduits greatly improve clinical outcome in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). PCI is feasible, safe, and effective in many patients with stable coronary artery disease who remain symptomatic despite medical treatment. In patients with multivessel and left main coronary artery disease, the decision between PCI or CABG is guided by the local Heart Team (team of different cardiovascular specialists, including non-invasive and invasive cardiologists, and cardiac surgeons), who carefully judge the possible benefits and risks inherent to PCI and CABG. In specific subsets, such as patients with diabetes and advanced, multivessel coronary artery disease, CABG remains the standard of care in view of improved protection against recurrent ischaemic adverse events.
Published: 2015

27. MortalitY in caRdIAc surgery (MYRIAD): A randomizeD controlled trial of volatile anesthetics. Rationale and design

Author: Landoni, G, Lomivorotov, V, Pisano, A, Nigro Neto, C, Benedetto, U, Biondi Zoccai, G, Gemma, M, Frassoni, S, Agro, F, Baiocchi, M, Barbosa Gomes Galas, F, Bautin, A, Bradic, N, Carollo, C, Crescenzi, G, Elnakera, A, El-Tahan, M, Fominskiy, E, Farag, A, Gazivoda, G, Gianni, S, Grigoryev, E, Guarracino, F, Hanafi, S, Huang, W, Kunst, G, Kunstyr, J, Lei, C, Lembo, R, Li, Z, Likhvantsev, V, Lozovskiy, A, Ma, J, Monaco, F, Navalesi, P, Nazar, B, Pasyuga, V, Porteri, E, Royse, C, Ruggeri, L, Riha, H, Santos Silva, F, Severi, L, Shmyrev, V, Uvaliev, N, Wang, C, Winterton, D, Yong, C, Yu, J, Bellomo, R, Zangrillo, A, Landoni G., Lomivorotov V., Pisano A., Nigro Neto C., Benedetto U., Biondi Zoccai G., Gemma M., Frassoni S., Agro F. E., Baiocchi M., Barbosa Gomes Galas F. R., Bautin A., Bradic N., Carollo C., Crescenzi G., Elnakera A. M., El-Tahan M. R., Fominskiy E., Farag A. G., Gazivoda G., Gianni S., Grigoryev E., Guarracino F., Hanafi S., Huang W., Kunst G., Kunstyr J., Lei C., Lembo R., Li Z. -J., Likhvantsev V., Lozovskiy A., Ma J., Monaco F., Navalesi P., Nazar B., Pasyuga V., Porteri E., Royse C., Ruggeri L., Riha H., Santos Silva F., Severi L., Shmyrev V., Uvaliev N., Wang C. B., Wang C. -Y., Winterton D., Yong C. -Y., Yu J., Bellomo R., Zangrillo A., Landoni, G, Lomivorotov, V, Pisano, A, Nigro Neto, C, Benedetto, U, Biondi Zoccai, G, Gemma, M, Frassoni, S, Agro, F, Baiocchi, M, Barbosa Gomes Galas, F, Bautin, A, Bradic, N, Carollo, C, Crescenzi, G, Elnakera, A, El-Tahan, M, Fominskiy, E, Farag, A, Gazivoda, G, Gianni, S, Grigoryev, E, Guarracino, F, Hanafi, S, Huang, W, Kunst, G, Kunstyr, J, Lei, C, Lembo, R, Li, Z, Likhvantsev, V, Lozovskiy, A, Ma, J, Monaco, F, Navalesi, P, Nazar, B, Pasyuga, V, Porteri, E, Royse, C, Ruggeri, L, Riha, H, Santos Silva, F, Severi, L, Shmyrev, V, Uvaliev, N, Wang, C, Winterton, D, Yong, C, Yu, J, Bellomo, R, Zangrillo, A, Landoni G., Lomivorotov V., Pisano A., Nigro Neto C., Benedetto U., Biondi Zoccai G., Gemma M., Frassoni S., Agro F. E., Baiocchi M., Barbosa Gomes Galas F. R., Bautin A., Bradic N., Carollo C., Crescenzi G., Elnakera A. M., El-Tahan M. R., Fominskiy E., Farag A. G., Gazivoda G., Gianni S., Grigoryev E., Guarracino F., Hanafi S., Huang W., Kunst G., Kunstyr J., Lei C., Lembo R., Li Z. -J., Likhvantsev V., Lozovskiy A., Ma J., Monaco F., Navalesi P., Nazar B., Pasyuga V., Porteri E., Royse C., Ruggeri L., Riha H., Santos Silva F., Severi L., Shmyrev V., Uvaliev N., Wang C. B., Wang C. -Y., Winterton D., Yong C. -Y., Yu J., Bellomo R., and Zangrillo A.
Abstract: Objective There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable. Design Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio. Setting Tertiary and University hospitals. Interventions Patients (n = 10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia. Measurements and main results The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30 day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9. Conclusions The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.
Published: 2017

28. On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin Pharmacodynamics: Effects of Improved Dosing Regimens

Author: Cavalca, V., Rocca, Bianca, Veglia, F., Petrucci, Giovanna, Porro, B., Myasoedova, V., De Cristofaro, Raimondo, Turnu, L., Bonomi, A., Songia, P., Cavallotti, L., Zanobini, M., Camera, M., Alamanni, F., Parolari, A., Patrono, Carlo, Tremoli, E., Rocca, Bianca (ORCID:0000-0001-8304-6423), Petrucci, Giovanna (ORCID:0000-0002-9280-3673), De Cristofaro, Raimondo (ORCID:0000-0002-8066-8849), Cavalca, V., Rocca, Bianca, Veglia, F., Petrucci, Giovanna, Porro, B., Myasoedova, V., De Cristofaro, Raimondo, Turnu, L., Bonomi, A., Songia, P., Cavallotti, L., Zanobini, M., Camera, M., Alamanni, F., Parolari, A., Patrono, Carlo, Tremoli, E., Rocca, Bianca (ORCID:0000-0001-8304-6423), Petrucci, Giovanna (ORCID:0000-0002-9280-3673), and De Cristofaro, Raimondo (ORCID:0000-0002-8066-8849)
Abstract: On-pump cardiac surgery may trigger inflammation and accelerate platelet cyclooxygenase-1 renewal, thereby modifying low-dose aspirin pharmacodynamics. Thirty-seven patients on standard aspirin 100 mg once-daily were studied before surgery and randomized within 36 hours postsurgery to 100 mg once-daily, 100 mg twice-daily, or 200 mg once-daily for 90 days. On day 7 postsurgery, immature and mature platelets, platelet mass, thrombopoietin, glycocalicin, leukocytes, C-reactive protein, and interleukin-6 significantly increased. Interleukin-6 significantly correlated with immature platelets. At day 7, patients randomized to 100 mg once-daily showed a significant increase in serum thromboxane (TX)B2within the 24-hour dosing interval and urinary TXA2metabolite (TXM) excretion. Aspirin 100 mg twice-daily lowered serum TXB2and prevented postsurgery TXM increase (P < 0.01), without affecting prostacyclin metabolite excretion. After cardiac surgery, shortening the dosing interval, but not doubling the once-daily dose, rescues the impaired antiplatelet effect of low-dose aspirin and prevents platelet activation associated with acute inflammation and enhanced platelet turnover.
Published: 2017

29. Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials

Author: Testa, Luca, Latib, Azeem, Bollati, Mario, Montone, Rocco Antonio, Colombo, Antonio, Crea, Filippo, Bedogni, Francesco, Crea, Filippo (ORCID:0000-0001-9404-8846), Testa, Luca, Latib, Azeem, Bollati, Mario, Montone, Rocco Antonio, Colombo, Antonio, Crea, Filippo, Bedogni, Francesco, and Crea, Filippo (ORCID:0000-0001-9404-8846)
Abstract: Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76â1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63â1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59â1.07), p = 0.14]. Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17â0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46â2.75), p<0.01]. At a median follow up of 5years, the rates of MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR 1.02(0.76â1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG 7.7%, OR 1(0.77â1.31), P = 0.9], MI [PCI 6.1% vs CABG 5%, OR 1.41(0.85â2.34), P = 0.19, I259%], and stroke [PCI 2% vs CABG 2.2%, OR 0.85(0.42â1.81), p = 0.65,] were similar while PCI was associated with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR 1.73(1.41â2.13), p<0.01]. Conclusion In patients with UPLM disease, PCI and CABG are associated with similar rates of MACE and mortality at 1 year as well as after 5 years. Differences can be detected for individual end points at both short and long term FU.
Published: 2017

30. MortalitY in caRdIAc surgery (MYRIAD):A randomizeD controlled trial of volatile anesthetics. Rationale and design

Author: Fernanda Santos Silva, Vladimir V. Lomivorotov, Samuele Frassoni, Abeer M Elnakera, Bukamal Nazar, Massimo Baiocchi, Dario Winterton, Felice Eugenio Agrò, Chong Lei, Jan Kunstyr, Luca Severi, Mohamed R. El-Tahan, Colin Royse, Evgeny Fominskiy, Rinaldo Bellomo, Vadim Pasyuga, Weiqing Huang, Jingui Yu, Antonio Pisano, Andrey Lozovskiy, Fabio Guarracino, Cristiana Carollo, Giuseppe Crescenzi, Marco Gemma, Jun Ma, Sidik Hanafi, Laura Ruggeri, Hynek Riha, Caetano Nigro Neto, Rosalba Lembo, Zhi jian Li, Gordana Gazivoda, Andrei Bautin, Filomena Regina Barbosa Gomes Galas, Chow Yen Yong, Ahmed G. Farag, Stefano Gianni, Nikola Bradic, Umberto Benedetto, Alberto Zangrillo, Paolo Navalesi, Cheng Bin Wang, Giovanni Landoni, Nikolay S Uvaliev, Gudrun Kunst, Vladimir Shmyrev, Valery Likhvantsev, Giuseppe Biondi Zoccai, Chew Yin Wang, Evgeny Grigoryev, Fabrizio Monaco, Elena Porteri, Landoni, Giovanni, Lomivorotov, Vladimir, Pisano, Antonio, Nigro Neto, Caetano, Benedetto, Umberto, Biondi Zoccai, Giuseppe, Gemma, Marco, Frassoni, Samuele, Agrò, Felice Eugenio, Baiocchi, Massimo, Barbosa Gomes Galas, Filomena R., Bautin, Andrei, Bradic, Nikola, Carollo, Cristiana, Crescenzi, Giuseppe, Elnakera, Abeer M., El Tahan, Mohamed R., Fominskiy, Evgeny, Farag, Ahmed G., Gazivoda, Gordana, Gianni, Stefano, Grigoryev, Evgeny, Guarracino, Fabio, Hanafi, Sidik, Huang, Weiqing, Kunst, Gudrun, Kunstyr, Jan, Lei, Chong, Lembo, Rosalba, Li, Zhi jian, Likhvantsev, Valery, Lozovskiy, Andrey, Ma, Jun, Monaco, Fabrizio, Navalesi, Paolo, Nazar, Bukamal, Pasyuga, Vadim, Porteri, Elena, Royse, Colin, Ruggeri, Laura, Riha, Hynek, Santos Silva, Fernanda, Severi, Luca, Shmyrev, Vladimir, Uvaliev, Nikolay, Wang, Cheng Bin, Wang, Chew Yin, Winterton, Dario, Yong, Chow Yen, Yu, Jingui, Bellomo, Rinaldo, Zangrillo, Alberto, Landoni, G, Lomivorotov, V, Pisano, A, Nigro Neto, C, Benedetto, U, Biondi Zoccai, G, Gemma, M, Frassoni, S, Agro, F, Baiocchi, M, Barbosa Gomes Galas, F, Bautin, A, Bradic, N, Carollo, C, Crescenzi, G, Elnakera, A, El-Tahan, M, Fominskiy, E, Farag, A, Gazivoda, G, Gianni, S, Grigoryev, E, Guarracino, F, Hanafi, S, Huang, W, Kunst, G, Kunstyr, J, Lei, C, Lembo, R, Li, Z, Likhvantsev, V, Lozovskiy, A, Ma, J, Monaco, F, Navalesi, P, Nazar, B, Pasyuga, V, Porteri, E, Royse, C, Ruggeri, L, Riha, H, Santos Silva, F, Severi, L, Shmyrev, V, Uvaliev, N, Wang, C, Winterton, D, Yong, C, Yu, J, Bellomo, R, and Zangrillo, A
Subjects: Adult, Male, Total intravenous anesthesia, Coronary Artery Disease, 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Intensive care, medicine, Clinical endpoint, Anesthesia, Cardiac Procedures, Humans, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, Cardiac anesthesia, Cardiac surgery, Randomized trial, Volatile anesthetics, business.industry, Coronary Artery Bypa, Medicine (all), General Medicine, medicine.disease, Intensive care unit, Survival Analysis, Volatile anesthetic, Outcome and Process Assessment, Health Care, Intravenous anesthesia, Anesthesia, Anesthetic, Anesthetics, Inhalation, Female, Survival Analysi, Volatilization, business, Anesthesia, Cardiac Procedure, Human, medicine.drug
Abstract: Objective There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable. Design Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio. Setting Tertiary and University hospitals. Interventions Patients (n = 10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia. Measurements and main results The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30 day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9. Conclusions The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.
Published: 2017

31. Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials

Author: Azeem Latib, Rocco A. Montone, Luca Testa, Francesco Bedogni, Antonio Colombo, Filippo Crea, Mario Bollati, Testa, Luca, Latib, Azeem, Bollati, Mario, Montone, Rocco Antonio, Colombo, Antonio, Crea, Filippo, and Bedogni, Francesco
Subjects: Genetics and Molecular Biology (all), Cardiovascular Procedures, medicine.medical_treatment, Myocardial Infarction, lcsh:Medicine, Social Sciences, 030204 cardiovascular system & hematology, Biochemistry, Vascular Medicine, law.invention, 0302 clinical medicine, Mathematical and Statistical Techniques, Randomized controlled trial, law, Medicine and Health Sciences, Coronary Heart Disease, 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, lcsh:Science, Stroke, Multidisciplinary, Coronary Artery Bypass Grafting, Medicine (all), surgical procedures, operative, Physical Sciences, Cardiology, Regression Analysis, Statistics (Mathematics), Human, Research Article, medicine.medical_specialty, Drug Research and Development, Surgical and Invasive Medical Procedures, Revascularization, Phonology, Research and Analysis Methods, Regression Analysi, 03 medical and health sciences, Percutaneous Coronary Intervention, Median follow-up, Internal medicine, medicine, Humans, Clinical Trials, cardiovascular diseases, Syntax, Statistical Methods, Pharmacology, Coronary Revascularization, Biochemistry, Genetics and Molecular Biology (all), business.industry, Coronary Artery Bypa, lcsh:R, Percutaneous coronary intervention, Linguistics, medicine.disease, Randomized Controlled Trials, Agricultural and Biological Sciences (all), Conventional PCI, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, lcsh:Q, Clinical Medicine, business, Mace, Mathematics, Meta-Analysis
Abstract: Background The optimal treatment of unprotected left main (UPLM) with either PCI or CABG remains uncertain. Aim The purpose of this study was to determine the comparative safety and efficacy of PCI versus CABG in patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL, mRCT, PubMed, major cardiological congresses proceedings and references cross-check (updated November 2016). Outcomes were the rate of MACE [all cause death, MI, stroke], the rates of the individual components of MACE and the rate of target vessel revascularisation (TVR). Results We identified 6 Randomised Controlled Trials totalling 4717 patients allocated to PCI or CABG. At 1 year follow up, PCI and CABG were substantially equivalent with respect to the rates of MACE [PCI 8.5% vs CABG 8.9%, OR 1.02,(0.76â1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR 0.81,(0.63â1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80 (0.59â1.07), p = 0.14]. Notably, PCI was associated with a significantly lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17â0.79), p = 0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%, OR 2.00(1.46â2.75), p
Published: 2017

32. Coronary artery bypass graft patients' perception about the risk factors of illness: Educational necessities of second prevention

Author: Behzad Heydarpour, Ali Soroush, Paolo Marchettini, Mario Fulcheri, Angelo Compare, Mozhgan Saeidi, Massimo Rabboni, Saeid Komasi, Danilo Carrozzino, Soroush A., Komasi S., Saeidi M., Heydarpour B., Carrozzino D., Fulcheri M., Marchettini P., Rabboni M., and Compare A.
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Pediatrics, Cross-sectional study, Cardiovascular disease, patients' perception, risk factors, second prevention, Cardiology and Cardiovascular Medicine, Anesthesiology and Pain Medicine, Disease, 030204 cardiovascular system & hematology, Overweight, Iran, Socioeconomic Factor, 0302 clinical medicine, Postoperative Complications, patients’ perception, Medicine, 030212 general & internal medicine, Family history, Coronary Artery Bypass, Aged, 80 and over, General Medicine, Middle Aged, Substance abuse, Original Article, Female, medicine.symptom, Human, Adult, medicine.medical_specialty, lcsh:RD78.3-87.3, 03 medical and health sciences, Patient Education as Topic, Internal medicine, Settore M-PSI/08 - Psicologia Clinica, Humans, Risk factor, Aged, Cross-Sectional Studie, business.industry, Coronary Artery Bypa, Risk Factor, medicine.disease, Obesity, Self Concept, Risk perception, Cross-Sectional Studies, Socioeconomic Factors, lcsh:Anesthesiology, lcsh:RC666-701, Postoperative Complication, business, Stress, Psychological
Abstract: Background: Patients' beliefs about the cause of cardiac disease (perceived risk factors) as part of the global psychological presentation are influenced by patients' health knowledge. Hence, the present study aimed to assess the relationship between actual and perceived risk factors, identification of underestimated risk factors, and indication of underestimation of every risk factor. Materials and Methods: In this cross-sectional study, data of 313 coronary artery bypass graft (CABG) patients admitted to one hospital in the west of Iran were collected through a demographic interview, actual risk factors' checklist, open single item of perceived risk factors, and a life stressful events scale. Data were analyzed by means of Spearman's correlation coefficients and one-sample Z-test for proportions. Results: Although there are significant relations between actual and perceived risk factors related to hypertension, family history, diabetes, smoking, and substance abuse (P < 0.05), there is no relation between the actual and perceived risk factors, and patients underestimate the role of actual risk factors in disease (P < 0.001). The patients underestimated the role of aging (98.8%), substance abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%), family history (90.3%), and hypertension (90%) more than diabetes (86.1%), smoking (72.5%), and stress (54.7%). Conclusion: Cardiac patients seem to underestimate the role of aging, substance abuse, obesity and overweight, hyperlipidemia, family history, and hypertension more than other actual risk factors. Therefore, these factors should be highlighted to patients to help them to (i) increase the awareness of actual risk factors and (ii) promote an appropriate lifestyle after CABG surgery.
Published: 2017

33. Geographical differences in the ratio of percutaneous and surgical myocardial revascularization procedures in the treatment of coronary artery disease

Author: Stephan Windecker, Philippe Kolh, Raffaele Piccolo, Piccolo, Raffaele, Windecker, Stephan, and Kolh, Philippe
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Myocardial revascularization, Percutaneous, medicine.medical_treatment, Coronary artery bypass grafting, 610 Medicine & health, Coronary Artery Disease, 030204 cardiovascular system & hematology, Percutaneous coronary intervention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Coronary Artery Bypass, Practice, SYNTAX trial, business.industry, Coronary Artery Bypa, General Medicine, medicine.disease, Treatment Outcome, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business, Human
Published: 2017
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34. Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low-risk patients

Author: Giuseppe Santarpino, Marco Zanobini, Tuomas Tauriainen, Filiberto Serraino, Carmelo Dominici, Riccardo Gherli, Marisa De Feo, Fausto Biancari, Francesco Musumeci, Francesca Fiorentino, Francesco Santini, Daniel Reichart, Sidney Chocron, Giuseppe Gatti, Antonio Salsano, Ciro Bancone, Francesco Nicolini, Antonino S. Rubino, Karl Bounader, Theodor Fischlein, Giuseppe Faggian, Giovanni Mariscalco, Matteo Saccocci, Jean Philippe Verhoye, Peter Svenarud, Luca Maschietto, Saverio Nardella, Vito G. Ruggieri, Francesco Onorati, Andrea Perrotti, Eeva-Maija Kinnunen, Magnus Dalén, Tiziano Gherli, Ilaria Franzese, Carmelo Mignosa, Daniele Maselli, Kinnunen, Em, De Feo, M, Reichart, D, Tauriainen, T, Gatti, G, Onorati, F, Maschietto, L, Bancone, C, Fiorentino, F, Chocron, S, Bounader, K, Dalén, M, Svenarud, P, Faggian, G, Franzese, I, Santarpino, G, Fischlein, T, Maselli, D, Dominici, C, Nardella, S, Gherli, R, Musumeci, F, Rubino, A, Mignosa, C, Mariscalco, G, Serraino, Fg, Santini, F, Salsano, A, Nicolini, F, Gherli, T, Zanobini, M, Saccocci, M, Ruggieri, Vg, Philippe Verhoye, J, Perrotti, A, and Biancari, F.
Subjects: Excessive Bleeding, Male, Registrie, medicine.medical_specialty, Blood transfusion, Blood management, Prognosi, medicine.medical_treatment, Tertiary Care Center, Immunology, 030204 cardiovascular system & hematology, Postoperative Hemorrhage, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Aged, Coronary Artery Bypass, Europe, Female, Humans, Incidence, Male, Middle Aged, Postoperative Hemorrhage, Prognosis, Prospective Studies, Risk Factors, Tertiary Care Centers, Blood Transfusion, Registries, Medicine, Humans, Immunology and Allergy, Blood Transfusion, Prospective Studies, Registries, Coronary Artery Bypass, Adverse effect, Prospective cohort study, Stroke, Aged, business.industry, Coronary Artery Bypa, Incidence, Risk Factor, Perioperative, Hematology, Middle Aged, medicine.disease, Prognosis, Surgery, Cardiac surgery, Europe, Prospective Studie, Female, 030228 respiratory system, business, Human
Abstract: BACKGROUND Excessive bleeding and blood transfusion are associated with adverse outcome after cardiac surgery, but their mechanistic effects are difficult to disentangle in patients with increased operative risk. This study aimed to evaluate the incidence and prognostic impact of bleeding and transfusion of blood products in low-risk patients undergoing coronary artery bypass grafting (CABG). STUDY DESIGN AND METHODS Sixteen tertiary European centers of cardiac surgery contributed to the prospective European registry of CABG (E-CABG). The severity of bleeding was defined by the E-CABG bleeding severity classification and universal definition of perioperative bleeding (UDPB) classification. RESULTS Of 1213 patients with EuroSCORE II of less than 2% (mean, 1.1 ± 0.4%), 18.5% suffered from mild bleeding (E-CABG bleeding Grade 1) and 3.4% experienced severe bleeding (E-CABG bleeding Grade 2-3). Similarly, 19.7% had UDPB Class 2 and 5.9% had UDPB Classes 3 and 4. Mild and severe bleeding defined by the E-CABG and UDPB classifications were associated with an increased risk of several adverse events as adjusted by multiple covariates. The risk of death, stroke, and acute kidney injury was particularly increased in patients with severe bleeding. CONCLUSION Severe bleeding is rather uncommon in low-risk patients undergoing CABG, but it is associated with an increased risk of major adverse events. Prevention of excessive perioperative bleeding and patient blood management may improve the outcome of cardiac surgery also in low-risk patients.
Published: 2017

35. Long-term results of sequential vein coronary artery bypass grafting compared with totally arterial myocardial revascularization: a propensity score-matched follow-up study

Author: Andrea Garatti, Livio Corain, Luigi Salmaso, Alberto Canziani, Tommaso Generali, Luigi Anastasia, Piervincenzo Gagliardotto, Serenella Castelvecchio, Lorenzo Menicanti, Francesca Giacomazzi, Eugenio Mossuto, Garatti, A., Castelvecchio, S., Canziani, A., Corain, L., Generali, T., Mossuto, E., Gagliardotto, P., Anastasia, L., Salmaso, L., Giacomazzi, F., and Menicanti, L.
Subjects: Male, CABG, arterial grafts, venous grafts, Ischaemic heart disease, angina, Outcomes, medicine.medical_treatment, Myocardial Ischemia, Kaplan-Meier Estimate, Angina, Retrospective Studie, Myocardial Revascularization, Medicine, Hospital Mortality, Myocardial infarction, Coronary Artery Bypass, Outcome, venous graft, education.field_of_study, Medicine (all), Angina Pectori, General Medicine, Middle Aged, Blood Vessel Prosthesi, Treatment Outcome, medicine.anatomical_structure, Italy, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Human, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Population, Revascularization, Asymptomatic, Angina Pectoris, Follow-Up Studie, Internal medicine, Humans, Propensity Score, education, Vein, Retrospective Studies, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, medicine.disease, Blood Vessel Prosthesis, Surgery, arterial graft, Propensity score matching, Exercise Test, business, Follow-Up Studies
Abstract: OBJECTIVES: The aim of the study was to analyse the early and long-term outcomes of a consecutive series of patients who underwent sequential coronary artery bypass grafting (CABG) and to compare them with a matched population of totally arterial revascularized patients. METHODS: From January 1994 to December 1996, 209 patients underwent total arterial myocardial revascularization at our institution [arterial (ART) group]. In the same period, 2097 patients underwent CABG with left internal thoracic artery on left anterior descending and great saphenous vein on the right and circumflex branches sequentially [sequential vein (SV) group]. The propensity score methodology was used to obtain risk-adjusted outcome comparisons between the two groups (209 vs 243 patients in the ART group and SV group, respectively). RESULTS: In-hospital mortality was 1% in the ART group and 0.4% in the SV group (P = 0.86). Mean follow-up was 14 ± 4 years. Long-term survival was comparable among the two study groups [actuarial 5- and 15-year survival rates were 97 vs 93% and 82 vs 79% in the ART group and the SV group, respectively (P = 0.29)]. At follow-up, recurrence of angina (17 vs 18%; P = 0.99), acute myocardial infarction (MI) (3 vs 5%; P = 0.72) and repeated percutaneous coronary intervention (19 vs 21%; P = 0.69) were similar in the ART group compared with the SV group. In the Cox regression analysis, type of revascularization was not an independent predictor of any long-term outcomes (death or major adverse cardiac events). In asymptomatic patients, exercise stress test at follow-up was comparable between the two groups (P = 0.14). CONCLUSIONS: Sequential vein CABG appears to have good early and long-term clinical outcomes. Also, early and long-term incidence of acute MI was not significantly higher in the SV group. However, further studies with a larger population are warranted in order to confirm the present results.
Published: 2014

36. Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients

Author: Marco Zanobini, Giovanni Mariscalco, Luca Maschietto, Fausto Biancari, Tiziano Gherli, Francesco Santini, Vito G. Ruggieri, Saverio Nardella, Daniele Maselli, Tuomas Tauriainen, Paola D'Errigo, Daniel Reichart, Francesco Musumeci, Antonino S. Rubino, Giuseppe Santarpino, Francesco Onorati, Sidney Chocron, Antonio Salsano, Marisa De Feo, Ciro Bancone, Riccardo Gherli, Tamas Püski, Karl Bounader, Theodor Fischlein, Andrea Perrotti, Carmelo Mignosa, Matteo Saccocci, Giuseppe Faggian, Helmut Gulbins, Giuseppe Gatti, Carmelo Dominici, Francesco Nicolini, Peter Svenarud, Eeva-Maija Kinnunen, Ilaria Franzese, Magnus Dalén, Oulu University Hospital [Oulu], Service de Chirurgie Cardiaque [CHU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Karolinska Institutet [Stockholm], University Hospital of Verona, CHU Pontchaillou [Rennes], University Heart Center Hamburg, Karolinska University Hospital [Stockholm], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), St Anna Hospital, S. Camillo-Forlanini Hospital, Morgagni-Pierantoni Hospital, Università degli studi di Napoli Federico II, Ospedali Riuniti, University of Genoa (UNIGE), University of Parma = Università degli studi di Parma [Parme, Italie], Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Superiore di Sanita [Rome], Biancari, Fausto, Tauriainen, Tuoma, Perrotti, Andrea, Dalén, Magnu, Faggian, Giuseppe, Franzese, Ilaria, Chocron, Sidney, Ruggieri, Vito G., Bounader, Karl, Gulbins, Helmut, Reichart, Daniel, Svenarud, Peter, Santarpino, Giuseppe, Fischlein, Theodor, Puski, Tama, Maselli, Daniele, Dominici, Carmelo, Nardella, Saverio, Mariscalco, Giovanni, Gherli, Riccardo, Musumeci, Francesco, Rubino, Antonino S., Mignosa, Carmelo, DE FEO, Marisa, Bancone, Ciro, Gatti, Giuseppe, Maschietto, Luca, Santini, Francesco, Salsano, Antonio, Nicolini, Francesco, Gherli, Tiziano, Zanobini, Marco, Saccocci, Matteo, D'Errigo, Paola, Kinnunen, Eeva Maija, Onorati, Francesco, University of Naples Federico II = Università degli studi di Napoli Federico II, Università degli studi di Genova = University of Genoa (UniGe), Università degli studi di Parma = University of Parma (UNIPR), and Istituto Superiore di Sanità (ISS)
Subjects: Registrie, Male, Blood transfusion, medicine.medical_treatment, Coronary artery bypass grafting, 030204 cardiovascular system & hematology, law.invention, Coronary artery bypass surgery, 0302 clinical medicine, law, Risk Factors, Prospective Studies, Registries, Coronary Artery Bypass, Prospective cohort study, Stroke, Bleeding, Cardiac surgery, Transfusion, Aged, Cardiopulmonary Bypass, Female, Hemorrhage, Heparin, Humans, Middle Aged, Postoperative Hemorrhage, Surgery, Cardiopulmonary Bypa, General Medicine, 3. Good health, Human, Cohort study, medicine.medical_specialty, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Cardiopulmonary bypass, medicine, business.industry, Coronary Artery Bypa, Risk Factor, Bleeding, Cardiac surgery, Coronary artery bypass grafting, Coronary artery bypass surgery, Stroke, Transfusion, Aged, Cardiopulmonary Bypass, Coronary Artery Bypass, Female, Hemorrhage, Heparin, Humans, Male, Middle Aged, Postoperative Hemorrhage, Prospective Studies, Registries, Risk Factors, Stroke, Perioperative, medicine.disease, Prospective Studie, 030228 respiratory system, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract: International audience; INTRODUCTION: This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery.METHODS: This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions.RESULTS: Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding.CONCLUSIONS: Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.
Published: 2016

37. Biomarkers in Coronary Artery Bypass Surgery: Ready for Prime Time and Outcome Prediction?

Author: Alessandro eParolari, Paolo ePoggio, Veronika eMyasoedova, Paola eSongia, Giorgia eBonalumi, Alberto ePilozzi, Davide ePacini, Francesco eAlamanni, Elena eTremoli, Parolari, Alessandro, Poggio, Paolo, Myasoedova, Veronika, Songia, Paola, Bonalumi, Giorgia, Pilozzi, Alberto, Pacini, Davide, Alamanni, Francesco, and Tremoli, Elena
Subjects: Genetic Markers, Change over time, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Dynamic markers, Review, Disease, 030204 cardiovascular system & hematology, Cardiovascular Medicine, Biomarkers, Pharmacological, outcome prediction, 03 medical and health sciences, Coronary artery bypass surgery, 0302 clinical medicine, medicine, 030212 general & internal medicine, Intensive care medicine, dynamic, business.industry, Mortality rate, coronary artery bypa, biomarkers, Perioperative, Surgical procedures, Surgery, coronary artery bypass, lcsh:RC666-701, outcome, biomarker, genetic, Cardiology and Cardiovascular Medicine, business, Outcome prediction, Complication
Abstract: Coronary artery bypass surgery (CABG) is still one of the most frequently performed surgical procedures all over the world. The results of this procedure have been constantly improved over the years with low perioperative mortality rates, and with relatively low complication rates. To further improve these outstanding results the clinicians focused their attention at biomarkers as outcome predictors. Although biological testing for disease prediction has already been discussed many times, the role of biomarkers in outcome prediction after CABG is still controversial. In this paper we reviewed the current knowledge regarding the role of genetic and dynamic biomarkers and their possible association with the occurrence of adverse clinical outcomes after CABG. We also took into consideration the molecular pathway activation and the possible imbalance that may affect hard outcomes and graft patency. We analysed biomarkers classified in two different categories depending on their possibility to change over time: genetic markers and dynamic markers. Moreover, we evaluated these markers by dividing them, into sub-categories, such as inflammation, haemostasis, renin-angiotensin, endothelial function and other pathways. We showed that biomarkers might be associated with unfavourable outcomes after surgery, and in some cases improved outcome prediction. However, the identification of a specific panel of biomarkers or of some algorithms including biomarkers is still in an early developmental phase. Finally, larger studies are needed to analyse broad panel of biomarkers with the specific aim to evaluate the prediction of hard outcomes and graft patency.
Published: 2016
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38. Myocardial Revascularization for Left Main Coronary Artery Disease: A Step Toward Individualized Treatment Selection

Author: Piccolo, Raffaele, Windecker, Stephan, Windecker, Stephan, and Piccolo, Raffaele
Subjects: Percutaneous Coronary Intervention, Treatment Outcome, coronary artery bypass graft, myocardial revascularization, Coronary Artery Bypa, left main disease, Coronary Artery Disease, 610 Medicine & health, Cardiology and Cardiovascular Medicine, Human
Published: 2016

39. Individualized strategy for clopidogrel suspension in patients undergoing coronary surgery: Is it the best choice?

Author: Luigi Mannacio, Giovanni Battista Pinna, Carlo Vosa, Vito Mannacio, Mannacio, VITO ANTONIO, Mannacio, Luigi, Pinna, GIOVANNI BATTISTA, and Vosa, Carlo
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Ticlopidine, Coronary surgery, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Coronary artery bypa, In patient, Coronary Artery Bypass, Suspension (vehicle), business.industry, Bleeding, General Medicine, Clopidogrel, Surgery, Platelet aggregation inhibitor, Editorial, 030228 respiratory system, business, Cardiology and Cardiovascular Medicine, Platelet Aggregation Inhibitors, medicine.drug
Published: 2016

40. How to delineate obstructive sleep apnea and continuous positive airway pressure link in postoperative atrial fibrillation conundrum?

Author: Luca Salvatore De Santo, Antonio M. Esquinas, De Santo, Luca Salvatore, and Esquinas, Antonio M.
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Continuous positive airway pressure, Coronary artery bypass grafting, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Sleep Apnea Syndromes, Sleep Apnea Syndrome, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Coronary Artery Bypass, business.industry, Coronary Artery Bypa, Atrial fibrillation, medicine.disease, Obstructive sleep apnea, Postoperative atrial fibrillation, Anesthesia, Cardiology, Noninvasive ventilation, Female, business, Human
Published: 2016

41. Computing Methods for Composite ClinicalÂ Endpoints in Unprotected Left Main Coronary Artery Revascularization: A Post Hoc Analysis of the DELTA Registry

Author: Capodanno D., Gargiulo G., Buccheri S., Chieffo A., Meliga E., Latib A., Park S. -J., Onuma Y., Capranzano P., Valgimigli M., Narbute I., Makkar R. R., Palacios I. F., Kim Y. -H., Buszman P. E., Chakravarty T., Sheiban I., Mehran R., Naber C., Margey R., Agnihotri A., Marra S., Leon M. B., Moses J. W., Fajadet J., Lefevre T., Morice M. -C., Erglis A., Alfieri O., Serruys P. W., Colombo A., Tamburino C., Capodanno, Davide, Gargiulo, Giuseppe, Buccheri, Sergio, Chieffo, Alaide, Meliga, Emanuele, Latib, Azeem, Park, Seung Jung, Onuma, Yoshinobu, Capranzano, Piera, Valgimigli, Marco, Narbute, Inga, Makkar, Raj R., Palacios, Igor F., Kim, Young Hak, Buszman, Pawel E., Chakravarty, Tarun, Sheiban, Imad, Mehran, Roxana, Naber, Christoph, Margey, Ronan, Agnihotri, Arvind, Marra, Sebastiano, Leon, Martin B., Moses, Jeffrey W., Fajadet, Jean, Lefã¨vre, Thierry, Morice, Marie Claude, Erglis, Andrej, Alfieri, Ottavio, Serruys, Patrick W., Colombo, Antonio, Tamburino, Corrado, Cardiology, Capodanno, D., Gargiulo, G., Buccheri, S., Chieffo, A., Meliga, E., Latib, A., Park, S. -J., Onuma, Y., Capranzano, P., Valgimigli, M., Narbute, I., Makkar, R. R., Palacios, I. F., Kim, Y. -H., Buszman, P. E., Chakravarty, T., Sheiban, I., Mehran, R., Naber, C., Margey, R., Agnihotri, A., Marra, S., Leon, M. B., Moses, J. W., Fajadet, J., Lefevre, T., Morice, M. -C., Erglis, A., Alfieri, O., Serruys, P. W., Colombo, A., and Tamburino, C.
Subjects: Registrie, Male, Data Interpretation, Time Factors, Logistic Model, Time Factor, Endpoint Determination, left main, win ratio, Myocardial Infarction, Coronary Artery Disease, Kaplan-Meier Estimate, competing risk, Risk Assessment, Percutaneous Coronary Intervention, Risk Factors, Models, Drug-Eluting Stent, Humans, Registries, Coronary Artery Bypass, Propensity Score, Multivariate Analysi, Aged, Proportional Hazards Models, Andersen-Gill, Models, Statistical, Coronary Artery Bypa, Risk Factor, Drug-Eluting Stents, Markov Chain, Statistical, Middle Aged, weighted composite event(s), Cerebrovascular Disorders, Data Interpretation, Statistical, Female, Logistic Models, Markov Chains, Multivariate Analysis, Research Design, Treatment Outcome, Cardiology and Cardiovascular Medicine, Cerebrovascular Disorder, Proportional Hazards Model, Human
Abstract: Objectives The study sought to investigate the impact of different computing methods for composite endpoints other than time-to-event (TTE) statistics in a large, multicenter registry of unprotected left main coronary artery (ULMCA) disease. Background TTE statistics for composite outcome measures used in ULMCA studies consider only the first event, and all the contributory outcomes are handled as if of equal importance. Methods The TTE, Andersen-Gill, win ratio (WR), competing risk, and weighted composite endpoint (WCE) computing methods were applied to ULMCA patients revascularized by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) at 14 international centers. Results At a median follow-up of 1,295 days (interquartile range: 928 to 1,713 days), all analyses showed no difference in combinations of death, myocardial infarction, and cerebrovascular accident between PCI and CABG. When target vesselÂ revascularization was incorporated in the composite endpoint, the TTE (pÂ = 0.03), Andersen-Gill (pÂ = 0.04), WR (pÂ = 0.025), and competing risk (pÂ < 0.001) computing methods showed CABG to be significantly superior to PCI in the analysis of 1,204 propensity-matched patients, whereas incorporating the clinical relevance of the component endpoints using WCE resulted in marked attenuation of the treatment effect of CABG, with loss of significance for the difference between revascularization strategies (pÂ = 0.10). Conclusions In a large study of ULMCA revascularization, incorporating the clinical relevance of the individual outcomes resulted in sensibly different findings as compared with the conventional TTE approach. In particular, using theÂ WCE computing method, PCI and CABG were no longer significantly different with respect to the composite ofÂ death,Â myocardial infarction, cerebrovascular accident, or target vessel revascularization at a median of 3 years.
Published: 2016

42. Percutaneous revascularization of left main

Author: George Dangas, Tullio Palmerini, Laura Alessi, Nicole Rizzo, Palmerini T., Alessi L., Rizzo N., and Dangas G.
Subjects: medicine.medical_specialty, Time Factors, Percutaneous, medicine.medical_treatment, Myocardial Infarction, left main coronary disease, Coronary Angiography, Prosthesis Design, Revascularization, Severity of Illness Index, intravascular ultrasound, law.invention, Randomized controlled trial, Predictive Value of Tests, law, Internal medicine, Intravascular ultrasound, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Myocardial infarction, Angioplasty, Balloon, Coronary, Ultrasonography, Interventional, Evidence-Based Medicine, medicine.diagnostic_test, business.industry, Coronary Artery Bypa, Coronary Stenosis, Percutaneous coronary intervention, Drug-Eluting Stents, Thrombosis, General Medicine, medicine.disease, Surgery, Stenosis, Treatment Outcome, surgical procedures, operative, Practice Guidelines as Topic, Conventional PCI, Cardiology, Drug Therapy, Combination, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors
Abstract: Refinement of interventional techniques, adjunctive pharmacological therapy, and the introduction of drug-eluting stents have fostered new interest for the percutaneous treatment of unprotected left main coronary artery (ULMCA) stenosis. Several observational registries, some randomized trials and several meta-analyses have consistently shown no difference in mortality and myocardial infarction between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with ULMCA stenosis, but a higher rate of target vessel revascularization in patients treated with PCI. As a consequence, PCI of ULMCA stenosis has been upgraded to class IIa or IIb indication in the current European or American practice guidelines. However, several critical issues should be properly addressed when pursuing a percutaneous strategy for the treatment of ULMCA stenosis, such as the use of IVUS for procedural guidance, assessment of disease location, optimal technique for distal ULMCA stenosis, risk of stent thrombosis, optimal duration of dual antiplatelet therapy, and the most appropriate strategy for post-procedure follow up. Multidisciplinary team approach remains essential to provide a balanced information to the patient and to offer the beast treatment option. © 2011 Wiley Periodicals, Inc.
Published: 2012

43. Meta-Analysis of Radial Versus Femoral Artery Approach for Coronary Procedures in Patients with Previous Coronary Artery Bypass Grafting

Author: Rigattieri, Stefano, Sciahbasi, Alessandro, Brilakis, Emmanouil S., Burzotta, Francesco, Rathore, Sudhir, Pugliese, Francesco R., Fedele, Silvio, Ziakas, Antonios G., Zhou, Yu J., Guzman, Luis A., Anderson, Richard A., Burzotta, Francesco (ORCID:0000-0002-6569-9401), Rigattieri, Stefano, Sciahbasi, Alessandro, Brilakis, Emmanouil S., Burzotta, Francesco, Rathore, Sudhir, Pugliese, Francesco R., Fedele, Silvio, Ziakas, Antonios G., Zhou, Yu J., Guzman, Luis A., Anderson, Richard A., and Burzotta, Francesco (ORCID:0000-0002-6569-9401)
Abstract: Cardiac catheterization through the radial artery approach (RA) has been shown to significantly reduce access-site complications compared with the femoral artery approach (FA) in many clinical settings. However, in the subset of patients with previous coronary artery bypass grafting (CABG), optimal vascular access site for coronary angiography and intervention is still a matter of debate. We aimed to perform a systematic review and meta-analysis of available studies comparing RA with FA in patients with previous CABG. Data were extracted by two independent reviewers; weighted mean differences and 95% confidence interval (CI) were calculated for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes. Summary statistics were calculated by random-effects model using Review Manager 5.3 software. The meta-analysis included 1 randomized and 8 nonrandomized studies, with a total of 2,763 patients. Compared with FA, RA required similar procedural time (mean difference 3.24 minutes, 95% CI -1.76 to 8.25, p = 0.20), fluoroscopy time (mean difference 0.62 minutes, 95% CI -0.83 to 2.07, p = 0.40), and contrast volume (mean difference -2.58 ml, 95% CI -18.36 to 13.20, p = 0.75) and was associated with similar rate of procedural failure (OR 1.32, 95% CI 0.63 to 2.80, p = 0.46), higher rate of crossover to another vascular access (OR 7.0, 95% CI 2.74 to 17.87, p <0.0001), and lower risk of access-site complications (OR 0.46, 95%CI 0.26 to 0.80, p = 0.006). In conclusion, the present meta-analysis suggests that in patients with previous CABG undergoing coronary procedures, RA, compared with FA, is associated with increased crossover rate but may reduce access-site complications.
Published: 2016

44. Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials

Author: Benedetto, Umberto, Gaudino, Mario Fulvio Luigi, Ng, Colin, Biondi Zoccai, Giuseppe, D'Ascenzo, Fabrizio, Frati, Giacomo, Girardi, Leonard N., Angelini, Gianni D., Taggart, David P., Gaudino, Mario Fulvio Luigi (ORCID:0000-0001-7529-438X), Benedetto, Umberto, Gaudino, Mario Fulvio Luigi, Ng, Colin, Biondi Zoccai, Giuseppe, D'Ascenzo, Fabrizio, Frati, Giacomo, Girardi, Leonard N., Angelini, Gianni D., Taggart, David P., and Gaudino, Mario Fulvio Luigi (ORCID:0000-0001-7529-438X)
Abstract: Objective Current randomized controlled trials (RCTs) comparing percutaneous coronary intervention with drug eluting stent (DES-PCI) with coronary artery bypass grafting (CABG) in multivessel disease are underpowered to detect a difference in hard clinical end-points such as mortality, myocardial infarction and stroke. We aimed to overcome this limitation by conducting a meta-analysis of contemporary RCTs. Methods A systematic literature search was conducted for all RCTs comparing DES-PCI versus CABG in multivessel disease published through May 2015. Inverse variance weighting was used to pool data from individual studies (< 1 favouring DES-PCI and > 1 CABG favouring surgery). Results A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4 years, DES-PCI was associated with a significantly increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P < 0.001), MI (HR 2.02; 95%CI 1.57-2.58; P < 0.001) and repeat revascularization (HR 2.54; 95%CI 2.07-3.11; P = < 0.001). CABG marginally increased the risk of stroke (HR 0.70; 95%CI 0.50-0.98; P = 0.04). The absolute risk reduction for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG was larger than the absolute risk reduction for stroke (0.9%) with DES-PCI. Conclusion In patients with multivessel coronary disease, CABG was found to be superior to DES-PCI by reducing the risk of mortality and subsequent myocardial infarction at the expense of a marginally increased risk of stroke.
Published: 2016

45. Antiplatelet therapy suspension in patients undergoing coronary surgery for acute coronary syndrome: Is point-of-care guided strategy the best choice?

Author: Luigi Mannacio, Vito Mannacio, Giovanni Battista Pinna, Anita Antignano, Mannacio, V., Mannacio, L., Antignano, A., and Pinna, G. B.
Subjects: Acute coronary syndrome, medicine.medical_specialty, Ticlopidine, Point-of-Care System, Point-of-Care Systems, Coronary surgery, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, In patient, 030212 general & internal medicine, Coronary Artery Bypass, Acute Coronary Syndrome, Suspension (vehicle), Point of care, business.industry, Coronary Artery Bypa, Bleeding, medicine.disease, Surgery, Platelet aggregation inhibitor, Cardiology, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Human, medicine.drug
Published: 2017

46. Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass

Author: Francesco Formica, Lucilla D. Monti, Alberico L. Catapano, PierMarco Piatti, Ottavio Alfieri, Giovanni La Canna, Emanuele Bosi, Alessandra Rossodivita, Pietro Lucotti, Alessandro Castiglioni, Emanuela Setola, Maria Grazia Pala, Giovanni Paolini, Lucotti, P, Monti, L, Setola, E, La Canna, G, Castiglioni, A, Rossodivita, A, Pala, Mg, Formica, F, Paolini, G, Catapano, Al, Bosi, Emanuele, Alfieri, Ottavio, Piatti, P., Pala, M, Catapano, A, Bosi, E, Alfieri, O, and Piatti, P
Subjects: Male, medicine.medical_specialty, Endothelium, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Administration, Oral, Arginine, Placebos, chemistry.chemical_compound, Endocrinology, Insulin resistance, endothelial function, Double-Blind Method, Internal medicine, medicine, Humans, Coronary Artery Bypass, Endothelial dysfunction, Aged, systemic inflammation, Inflammation, Glucose tolerance test, medicine.diagnostic_test, Adiponectin, business.industry, coronary artery bypa, Insulin, Type 2 Diabetes Mellitus, Glucose Tolerance Test, Middle Aged, medicine.disease, MED/23 - CHIRURGIA CARDIACA, medicine.anatomical_structure, chemistry, diabete, Cardiovascular Diseases, Dietary Supplements, Female, Endothelium, Vascular, Insulin Resistance, Asymmetric dimethylarginine, business
Abstract: It is known that L-arginine treatment can ameliorate endothelial dysfunction and insulin sensitivity in type 2 diabetes mellitus patients, but little is known on L-arginine effects on these variables in nondiabetic patients with stable cardiovascular disease (coronary artery disease). We evaluated the effects of long-term oral L-arginine treatment on endothelial dysfunction, inflammation, adipokine levels, glucose tolerance, and insulin sensitivity in these patients. Sixty-four patients with cardiovascular disease previously submitted to an aortocoronary bypass and not known for type 2 diabetes mellitus had an oral glucose load to define their glucose tolerance. Thirty-two patients with nondiabetic response were eligible to receive, in a double-blind randomized parallel order, L-arginine (6.4 g/d) or placebo for 6 months. An evaluation of insulin sensitivity index during the oral glucose load, markers of systemic nitric oxide bioavailability and inflammation, and blood flow was performed before and at the end of the treatment in both groups. Compared with placebo, L-arginine decreased asymmetric dimethylarginine levels (P < .01), indices of endothelial dysfunction, and increased cyclic guanosine monophosphate (P < .01), L-arginine to asymmetric dimethylarginine ratio (P < .0001), and reactive hyperemia (P < .05). Finally, L-arginine increased insulin sensitivity index (P < .05) and adiponectin (P < .01) and decreased interleukin-6 and monocyte chemoattractant protein-1 levels. In conclusion, insulin resistance, endothelial dysfunction, and inflammation are important cardiovascular risk factors in coronary artery disease patients; and L-arginine seems to have anti-inflammatory and metabolic advantages in these patients.
Published: 2009

47. Five-year outcomes of percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with left main coronary artery disease: An updated meta-analysis of randomized trials and adjusted observational studies

Author: Corrado Tamburino, Giuseppe Gargiulo, Davide Capodanno, Gargiulo, G., Tamburino, C., and Capodanno, D.
Subjects: medicine.medical_specialty, Comparative Effectiveness Research, medicine.medical_treatment, Myocardial Infarction, Coronary Artery Disease, law.invention, Percutaneous coronary intervention, Randomized controlled trial, law, Internal medicine, Clinical outcomes, Coronary artery bypass graft, Left main, Medicine, In patient, Meta-analysi, Left main coronary artery disease, Meta-analysis, Randomized Controlled Trials as Topic, business.industry, Clinical outcome, Coronary Artery Bypa, Surgery, Stroke, Observational Studies as Topic, medicine.anatomical_structure, Treatment Outcome, Cardiology, Observational study, Cardiology and Cardiovascular Medicine, business, Artery, Human
Published: 2015

48. European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG registry): Study Protocol for a Prospective Clinical Registry and Proposal of Classification of Postoperative Complications

Author: Daniele Maselli, Vito G. Ruggieri, Alessandro Della Corte, Magnus Dalén, Tatu Juvonen, Giuseppe Faggian, Giuseppe Santarpino, Peter Svenarud, Riccardo Gherli, Saverio Nardella, Fausto Biancari, Francesco Onorati, Eeva-Maija Kinnunen, Carmelo Dominici, Francesco Musumeci, Giuseppe Gatti, Andrea Perrotti, Carmelo Mignosa, Giovanni Mariscalco, Marisa De Feo, Nicola Masala, Sidney Chocron, Ciro Bancone, Antonino S. Rubino, Tiziano Gherli, Biancari, Fausto, Ruggieri, Vito G., Perrotti, Andrea, Svenarud, Peter, Dalén, Magnu, Onorati, Francesco, Faggian, Giuseppe, Santarpino, Giuseppe, Maselli, Daniele, Dominici, Carmelo, Nardella, Saverio, Musumeci, Francesco, Gherli, Riccardo, Mariscalco, Giovanni, Masala, Nicola, Rubino, Antonino, Mignosa, Carmelo, DE FEO, Marisa, DELLA CORTE, Alessandro, Bancone, Ciro, Chocron, Sidney, Gatti, Giuseppe, Gherli, Tiziano, Kinnunen, Eeva Maija, Juvonen, Tatu, Oulu University Hospital [Oulu], CHU Pontchaillou [Rennes], Karolinska University Hospital [Stockholm], University Hospital of Verona, Paracelsus Medical University, St Anna Hospital, S. Camillo-Forlanini Hospital, University Hospitals Leicester, Morgagni-Pierantoni Hospital, Università degli studi di Napoli Federico II, Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( PCVP / CARDIO ), Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ) -Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( EA 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), University of Naples Federico II = Università degli studi di Napoli Federico II, and Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO)
Subjects: Registrie, Time Factors, [SDV]Life Sciences [q-bio], Myocardial Infarction, Coronary artery bypass grafting, 030204 cardiovascular system & hematology, law.invention, Study Protocol, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Risk Factors, Medicine, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, E-CABG, Coronary Artery Bypass, Prospective cohort study, Stroke, CABG, Incidence, General Medicine, Middle Aged, 3. Good health, Cardiac surgery, Survival Rate, Europe, Treatment Outcome, Cardiothoracic surgery, Middle Aged Myocardial Infarction, Cardiology and Cardiovascular Medicine, Human, Pulmonary and Respiratory Medicine, medicine.medical_specialty, complications, Time Factor, complication, 03 medical and health sciences, Risk Factors Survival Rate, Humans, Adverse effect, Survival rate, [ SDV ] Life Sciences [q-bio], business.industry, Coronary Artery Bypa, Risk Factor, medicine.disease, Surgery, Prospective Studie, Coronary Artery Bypass, Europe, Humans, Incidence, Middle Aged Myocardial Infarction, Postoperative Complications, Prospective Studies, Risk Factors Survival Rate, Time Factors, Treatment Outcome, Registries, Emergency medicine, Postoperative Complication, business
Abstract: International audience; BACKGROUND: Clinical evidence in coronary surgery is usually derived from retrospective, single institutional series. This may introduce significant biases in the analysis of critical issues in the treatment of these patients. In order to avoid such methodological limitations, we planned a European multicenter, prospective study on coronary artery bypass grafting, the E-CABG registry. DESIGN: The E-CABG registry is a multicenter study and its data are prospectively collected from 13 centers of cardiac surgery in university and community hospitals located in six European countries (England, Italy, Finland, France, Germany, Sweden). Data on major and minor immediate postoperative adverse events will be collected. Data on late all-cause mortality, stroke, myocardial infarction and repeat revascularization will be collected during a 10-year follow-up period. These investigators provided a score from 0 to 10 for any major postoperative adverse events and their rounded medians were used to stratify the severity of these complications in four grades. The sum of these scores for each complication/intervention occurring after coronary artery bypass grafting will be used as an additive score for further stratification of the prognostic importance of these events. DISCUSSION: The E-CABG registry is expected to provide valuable data for identification of risk factors and treatment strategies associated with suboptimal outcome. These information may improve the safety and durability of coronary artery bypass grafting. The proposed classification of postoperative complications may become a valuable research tool to stratify the impact of such complications on the outcome of these patients and evaluate the burden of resources needed for their treatment. CLINICAL TRIALS NUMBER: NCT02319083
Published: 2015

49. Management and outcome of patients with established coronary artery disease: the Euro Heart Survey on coronary revascularization

Author: Lenzen, M. J., Boersma, E., Bertrand, M. E., Maier, W., Moris, C., Piscione, F., Sechtem, U., Stahle, E., Widimsky, P., De Jaegere, P., Scholte Op Reimer, W. J. M., Mercado, N., Wijns, W., Meier, B., Sergeant, P., Vos, J., Unger, F., Manini, Malika, Bramley, Claire, Laforest, Valérie, Taylor, Charles, Del Gaiso, Susan, Huber, Kurt, De Backer, Guy, Sirakova, Vera, Cerbak, Roman, Thayssen, Per, Lehto, Seppo, Blanc, Jean-Jacques, Delahaye, François, Kobulia, Bondo, Zeymer, Uwe, Cokkinos, Dennis, Karlocai, Kristof, Graham, Ian, Shelley, Emer, Behar, Shlomo, Maggioni, Aldo, Grabauskiene, Virginija, Deckers, Jaap, Asmussen, Inger, Stepinska, Janina, Gonçalves, Lino, Mareev, Vyacheslav, Riecansky, Igor, Kenda, Miran F., Alonso, Angeles, Lopez-Sendon, José Luis, Rosengren, Annika, Buser, Peter, Okay, Tugrul, Sychov, Oleg, Fox, Kevin, Wood, David, Boersma, Eric, Crijns, Harry, Fox, Kim, McGregor, Keith, Mulder, Barbara, Priori, Sylvia, Rydén, Lars, Tavazzi, Luigi, Vahanian, Alec, Vardas, Panos, Wijns, William, Sarkisyan, Karine, Glogar, H. D., Derntl, Michael, Frick, Matthias, Pachinger, O., Zwick, Ralf, Vrints, Christiaan, Van Hertbruggen, Els, Vercammen, Marc, Sysmans, Tineke, Schroeder, E., Domange, Juliette, De Pril, Hilde, De Vriese, Johan, Van Hecke, Tonny, Legrand, V., Gillon, Marie-France, Richardy, Michel, Doneux, P., Petrov, Ivo, Jorgova, J., Starcevic, Boris, Eeckhout, Eric, Berger, Alexandre, Prudent, Veronique, Camenzind, E., Masson, Nicolas, Zambartas, Costas, Kleanthous, Helen, Widimsky, Petr, Stellova, Blanka, Aschermann, Michael, Simek, Stanislav, Kautzner, J., Karmazin, Vladimir, Svab, P., Indrak, Jan, Branny, M., Hladilova, Kveta, Kala, P., Thayssen, P., Cappelen, Helle, Jensen, Lisette Okkels, Gitt, A., Gehrke, Konstanze, Erbel, R., Gutersohn, Achim, Eggebrecht, Holger, Al Khani, Murad, Sechtem, Udo, Rosenberger, Antje, Vogelsberg, Holger, Klepzig, H., Schmidt, Arnold, Silber, Sigmund, Mau, Birgit, Leuner, Christian, Czyborra, Karen, Reuschling, Christina, Muno, Eva, Kleber, F., Rux, Sascha, Zeymer, U., Saad, Aly, Ibrahim, B. S. S., Elabady, Maged, Castro Beiras, A., Fernandez, Jorge Salgado, Navarro Del Arno, Felipe, Iniguez Romo, A., Cruz Fernandez, J. M., Mayoreal, Alejandro Recio, Rebanal, Franciso Javier Rivero, De La Borbolla, Mariano Garcia, Chaparro, Marinela, Brotons, C., Permanyer Miralda, C., Vilai Perez, Srta Irma, Moris, Cesar, Fernandez Aviles, F., De La Fuente Galan, Luis, Vinuela, Paula Tejedor, Malpartida De Torres, F., Mora, Javier, Rodriguez, Ignacio Santos, Bustamante, Itziar Piedra, Sanchez Fernandez, Pedro L., Diago Torrent, J. L., Diez Gil, Jose L., Perpinan, Javier, Palacios Motilla, V., Soledad Alcasena Juango, M., Berjon-Reyero, Jesus, Melgares Moreno, R., Guerrero, Juan Carlos Fernandez, Lehto, S., Savolainen, Kirsti, Nieminen, M. S., Syvanne, Mikko, Cohen-Solal, A., Oboa, Antoine-Sylvain, Bassand, J. P., Espinosa, Denis Pales, Jouet, Veronique, Montalescot, G., Gallois, Vanessa, Daubert, J. C., Clerc, Jean Michel, Machecourt, Jacques, Cottin, Y., Walker, D., Holland, Fhiona, Wood, D., Prosser, Jenni, Muir, Lis, Barber, Kate, Cleland, J. G. F., Cook, Jocelyn, Chapichadze, Zaza, Christos, Ioannis Skoularigisn Athanasiou, Tsiavou, Nastasia, Chrysohoou, Christina, Manginas, Athanassios, Terrovitis, John, Kanakakis, John, Vavuranakis, Manolis, Drakos, Stavros, Farmakis, Thomas, Samara, C., Papakosta, Christina, Bourantas, Christos, Michalis, L. K., Christos, Mpourantas, Foussas, Stefanos, Adamopoulou, Evdokia, Vardas, P. E., Marketou, Mary, Alotti, N., Basa, Anna Maria, Vigh, Andras, Preda, Istvan, Csoti, Eva, Keltai, M., Kerkovits, G., Hendler, Alberto, Blatt, Alex, Beyar, R., Shefer, Arie, Halon, David, Bentzvi, Margalait, Avramovitch, Naomi, Bakst, Avinoam, Cafri, Carlos, Grosbard, Aviva, Margolis, Bella, Suleiman, Khalid, Banai, Shmuel, Meerkin, David, Mosseri, Morris, Guita, Pnina, Jabara, Rifat, Jafari, Jamal, Ben Shitrit, Debi, Ghasan, null, Salameh, null, Brezins, Marc, Van Den Akker-Berman, Lily, Guetta, Victor, Rozenman, Yoseph, Biagini, A., Berti, Sergio, Ferrero, Massimo, Colombo, A., Roccaforte, R., Milici, Caterina, Scarpino, L., Salvi, A., Desideri, Alessandro, Sabbadin, Daniela, Galassi, Alfredo, Giuffrida, Giuseppe, Rognoni, Andrea, Vassanelli, Corrado, Paffoni, Paola, Cioppa, Angelo, Rubino, Paolo, De Carlo, Marco, Petronio, Anna Sonia, Naccarella, F., Saia, Francesco, Marzocchi, Antonio, Maranga, Stefano Sdringola, Presbitero, P., Valsecchi, Fazya, Piscione, Federico, Esposito, Giovanni, Santini, Napoli M., Tubaro, Marco, Erglis, A., Narbute, Inga, Kavoliuniene, Ausra, Zaliunas, R., Navickas, Ramunas, Grabauskiene, V., Luckute, Davia, Subkovas, Eduardas, Wagner, Daniel, Vermeer, F., Lousberg, Aimee, Fransen, Heidi, Breeman, Arno, Tebbe, Henriette, De Boer, M. J., Van Der Wal, Metske, Deckers, J., Vos, Jeroen, Leenders, C. M., Veerhoek, M. J., Jansen, Chris, Bijl, M., Koppelaar, Colinda, Van Den Linden, null, Brons, R., Widdershofen, J. W. M. G., Broers, Herman, Kontny, F., Jonzon, Marianne, Wodniecki, Jan, Tomasik, Andrzej, Trusz-Gluza, M., Nowak, Seweryn, Ruzyllo, Witold, Deptuch, Tomasz, Marques, Jorge, Matias, F., Madeira, H., Oliveira, Joaquim, Sargento, Luis, Ionac, Adina, Dragulescu, Iosif Stefan, Mut-Vitcu, Bogdan, Maximov, Daniela, Dorobantu, M., Apetrei, E., Niculescu, Rodica, Petrescu, Virgil, Bucsa, Adrian, Deleanu, Dan, Benedek, I. S., Hintea, Theodora, Aronov, D., Tikhomirova, Elena, Kranjec, I., Prokselj, Katja, Kanic, Vojko, Sepetoglu, Ahmet, Aytekin, S., Aytekin, V., Catakoglu, Alp Burak, Parlar, Hayri, Tufekcioglu, Suavi, Ozyedek, Zeki, Baltali, Mehmet, Kiziltan, null, Vukovic, Milan, Neskovic, A. N., Lenzen, M. J, Boersma, E, Bertrand, Me, Maier, W, Moris, C, Esposito, Giovanni, Piscione, Federico, Sechtem, U, Stahle, E, Widimsky, P, de Jaegere, P, Scholte op Reimer, W. J. M, Mercado, N, Wijns, W., University of Zurich, Wijns, W, Lenzen, M. J., Boersma, E., Bertrand, M. E., Maier, W., Moris, C., Piscione, F., Sechtem, U., Stahle, E., Widimsky, P., De Jaegere, P., Scholte Op Reimer, W. J. M., Mercado, N., Meier, B., Sergeant, P., Vos, J., Unger, F., Manini, Malika, Bramley, Claire, Laforest, Valérie, Taylor, Charle, Del Gaiso, Susan, Huber, Kurt, De Backer, Guy, Sirakova, Vera, Cerbak, Roman, Thayssen, Per, Lehto, Seppo, Blanc, Jean-Jacque, Delahaye, Françoi, Kobulia, Bondo, Zeymer, Uwe, Cokkinos, Denni, Karlocai, Kristof, Graham, Ian, Shelley, Emer, Behar, Shlomo, Maggioni, Aldo, Grabauskiene, Virginija, Deckers, Jaap, Asmussen, Inger, Stepinska, Janina, Gonçalves, Lino, Mareev, Vyacheslav, Riecansky, Igor, Kenda, Miran F., Alonso, Angele, Lopez-Sendon, José Lui, Rosengren, Annika, Buser, Peter, Okay, Tugrul, Sychov, Oleg, Fox, Kevin, Wood, David, Boersma, Eric, Crijns, Harry, Fox, Kim, Mcgregor, Keith, Mulder, Barbara, Priori, Sylvia, Rydén, Lar, Tavazzi, Luigi, Vahanian, Alec, Vardas, Pano, Wijns, William, Sarkisyan, Karine, Glogar, H. D., Derntl, Michael, Frick, Matthia, Pachinger, O., Zwick, Ralf, Vrints, Christiaan, Van Hertbruggen, El, Vercammen, Marc, Sysmans, Tineke, Schroeder, E., Domange, Juliette, De Pril, Hilde, De Vriese, Johan, Van Hecke, Tonny, Legrand, V., Gillon, Marie-France, Richardy, Michel, Doneux, P., Petrov, Ivo, Jorgova, J., Starcevic, Bori, Eeckhout, Eric, Berger, Alexandre, Prudent, Veronique, Camenzind, E., Masson, Nicola, Zambartas, Costa, Kleanthous, Helen, Widimsky, Petr, Stellova, Blanka, Aschermann, Michael, Simek, Stanislav, Kautzner, J., Karmazin, Vladimir, Svab, P., Indrak, Jan, Branny, M., Hladilova, Kveta, Kala, P., Thayssen, P., Cappelen, Helle, Jensen, Lisette Okkel, Gitt, A., Gehrke, Konstanze, Erbel, R., Gutersohn, Achim, Eggebrecht, Holger, Al Khani, Murad, Sechtem, Udo, Rosenberger, Antje, Vogelsberg, Holger, Klepzig, H., Schmidt, Arnold, Silber, Sigmund, Mau, Birgit, Leuner, Christian, Czyborra, Karen, Reuschling, Christina, Muno, Eva, Kleber, F., Rux, Sascha, Zeymer, U., Saad, Aly, Ibrahim, B. S. S., Elabady, Maged, Castro Beiras, A., Fernandez, Jorge Salgado, Navarro Del Arno, Felipe, Iniguez Romo, A., Cruz Fernandez, J. M., Mayoreal, Alejandro Recio, Rebanal, Franciso Javier Rivero, De La Borbolla, Mariano Garcia, Chaparro, Marinela, Brotons, C., Permanyer Miralda, C., Vilai Perez, Srta Irma, Moris, Cesar, Fernandez Aviles, F., De La Fuente Galan, Lui, Vinuela, Paula Tejedor, Malpartida De Torres, F., Mora, Javier, Rodriguez, Ignacio Santo, Bustamante, Itziar Piedra, Sanchez Fernandez, Pedro L., Diago Torrent, J. L., Diez Gil, Jose L., Perpinan, Javier, Palacios Motilla, V., Soledad Alcasena Juango, M., Berjon-Reyero, Jesu, Melgares Moreno, R., Guerrero, Juan Carlos Fernandez, Lehto, S., Savolainen, Kirsti, Nieminen, M. S., Syvanne, Mikko, Cohen-Solal, A., Oboa, Antoine-Sylvain, Bassand, J. P., Espinosa, Denis Pale, Jouet, Veronique, Montalescot, G., Gallois, Vanessa, Daubert, J. C., Clerc, Jean Michel, Machecourt, Jacque, Cottin, Y., Walker, D., Holland, Fhiona, Wood, D., Prosser, Jenni, Muir, Li, Barber, Kate, Cleland, J. G. F., Cook, Jocelyn, Chapichadze, Zaza, Christos, Ioannis Skoularigisn Athanasiou, Tsiavou, Nastasia, Chrysohoou, Christina, Manginas, Athanassio, Terrovitis, John, Kanakakis, John, Vavuranakis, Manoli, Drakos, Stavro, Farmakis, Thoma, Samara, C., Papakosta, Christina, Bourantas, Christo, Michalis, L. K., Christos, Mpouranta, Foussas, Stefano, Adamopoulou, Evdokia, Vardas, P. E., Marketou, Mary, Alotti, N., Basa, Anna Maria, Vigh, Andra, Preda, Istvan, Csoti, Eva, Keltai, M., Kerkovits, G., Hendler, Alberto, Blatt, Alex, Beyar, R., Shefer, Arie, Halon, David, Bentzvi, Margalait, Avramovitch, Naomi, Bakst, Avinoam, Cafri, Carlo, Grosbard, Aviva, Margolis, Bella, Suleiman, Khalid, Banai, Shmuel, Meerkin, David, Mosseri, Morri, Guita, Pnina, Jabara, Rifat, Jafari, Jamal, Ben Shitrit, Debi, Ghasan, Null, Salameh, Null, Brezins, Marc, Van Den Akker-Berman, Lily, Guetta, Victor, Rozenman, Yoseph, Biagini, A., Berti, Sergio, Ferrero, Massimo, Colombo, A., Roccaforte, R., Milici, Caterina, Scarpino, L., Salvi, A., Desideri, Alessandro, Sabbadin, Daniela, Galassi, Alfredo, Giuffrida, Giuseppe, Rognoni, Andrea, Vassanelli, Corrado, Paffoni, Paola, Cioppa, Angelo, Rubino, Paolo, De Carlo, Marco, Petronio, Anna Sonia, Naccarella, F., Saia, Francesco, Marzocchi, Antonio, Maranga, Stefano Sdringola, Presbitero, P., Valsecchi, Fazya, Santini, Napoli M., Tubaro, Marco, Erglis, A., Narbute, Inga, Kavoliuniene, Ausra, Zaliunas, R., Navickas, Ramuna, Grabauskiene, V., Luckute, Davia, Subkovas, Eduarda, Wagner, Daniel, Vermeer, F., Lousberg, Aimee, Fransen, Heidi, Breeman, Arno, Tebbe, Henriette, De Boer, M. J., Van Der Wal, Metske, Deckers, J., Vos, Jeroen, Leenders, C. M., Veerhoek, M. J., Jansen, Chri, Bijl, M., Koppelaar, Colinda, Van Den Linden, Null, Brons, R., Widdershofen, J. W. M. G., Broers, Herman, Kontny, F., Jonzon, Marianne, Wodniecki, Jan, Tomasik, Andrzej, Trusz-Gluza, M., Nowak, Seweryn, Ruzyllo, Witold, Deptuch, Tomasz, Marques, Jorge, Matias, F., Madeira, H., Oliveira, Joaquim, Sargento, Lui, Ionac, Adina, Dragulescu, Iosif Stefan, Mut-Vitcu, Bogdan, Maximov, Daniela, Dorobantu, M., Apetrei, E., Niculescu, Rodica, Petrescu, Virgil, Bucsa, Adrian, Deleanu, Dan, Benedek, I. S., Hintea, Theodora, Aronov, D., Tikhomirova, Elena, Kranjec, I., Prokselj, Katja, Kanic, Vojko, Sepetoglu, Ahmet, Aytekin, S., Aytekin, V., Catakoglu, Alp Burak, Parlar, Hayri, Tufekcioglu, Suavi, Ozyedek, Zeki, Baltali, Mehmet, Kiziltan, Null, Vukovic, Milan, Neskovic, A. N., Cardiology, Lenzen, Mj, and Scholte op Reimer, Wj
Subjects: Practice survey, Male, Coronary Stenosi, Coronary angiography, medicine.medical_treatment, Myocardial Infarction, Coronary Artery Disease, Angina, Coronary artery disease, Myocardial Revascularization, Stent, Myocardial infarction, Coronary Artery Bypass, Angioplasty, Balloon, Coronary, CABG, PCI, Professional Practice, Health Survey, Middle Aged, Europe, Treatment Outcome, Epidemiologic Method, Practice Guidelines as Topic, Cardiology, Stents, Female, Guideline Adherence, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, outcome, Euro Heart Survey, 610 Medicine & health, Platelet Glycoprotein GPIIb-IIIa Complex, 142-005 142-005, 2705 Cardiology and Cardiovascular Medicine, Angioplasty, Internal medicine, medicine, Humans, Angina, Unstable, cardiovascular diseases, Interventional cardiology, Unstable angina, business.industry, Coronary Artery Bypa, Coronary Stenosis, Percutaneous coronary intervention, Length of Stay, medicine.disease, Health Surveys, Conventional PCI, 570 Life sciences, biology, Epidemiologic Methods, business
Abstract: AIMS: The purpose of the Euro Heart Survey Programme of the European Society of Cardiology is to evaluate to which extent clinical practice endorses existing guidelines as well as to identify differences in population profiles, patient management, and outcome across Europe. The current survey focuses on the invasive diagnosis and treatment of patients with established coronary artery disease (CAD). METHODS AND RESULTS: Between November 2001 and March 2002, 7769 consecutive patients undergoing invasive evaluation at 130 hospitals (31 countries) were screened for the presence of one or more coronary stenosis >50% in diameter. Patient demographics and comorbidity, clinical presentation, invasive parameters, treatment options, and procedural techniques were prospectively entered in an electronic database (550 variables+29 per diseased coronary segment). Major adverse cardiac events (MACE) were evaluated at 30 days and 1 year. Out of 5619 patients with angiographically proven coronary stenosis (72% of screened population), 53% presented with stable angina while ST elevation myocardial infarction (STEMI) was the indication for coronary angiography in 16% and non-ST segment elevation myocardial infarction or unstable angina in 30%. Only medical therapy was continued in 21%, whereas mechanical revascularization was performed in the remainder [percutaneous coronary intervention (PCI) in 58% and coronary artery bypass grafting (CABG) in 21%]. Patients referred for PCI were younger, were more active, had a lower risk profile, and had less comorbid conditions. CABG was performed mostly in patients with left main lesions (21%), two- (25%), or three-vessel disease (67%) with 4.1 diseased segments, on average. Single-vessel PCI was performed in 82% of patients with either single- (45%), two- (33%), or three-vessel disease (21%). Stents were used in 75% of attempted lesions, with a large variation between sites. Direct PCI for STEMI was performed in 410 cases, representing 7% of the entire workload in the participating catheterization laboratories. Time delay was within 90 min in 76% of direct PCI cases. In keeping with the recommendations of practice guidelines, the survey identified under-use of adjunctive medication (GP IIb/IIIa receptor blockers, statins, and angiotensin-converting enzyme-inhibitors). Mortality rates at 30 days and 1 year were low in all subgroups. MACE primarily consisted of repeat PCI (12%). CONCLUSION: The current Euro Heart Survey on coronary revascularization was performed in the era of bare metal stenting and provides a global European picture of the invasive approach to patients with CAD. These data will serve as a benchmark for the future evaluation of the impact of drug-eluting stents on the practice of interventional cardiology and bypass surgery.
Published: 2005

50. Morphological and functional consequences of transradial coronary angiography on the radial artery: Implications for its use as a bypass conduit

Author: Gaudino, Mario Fulvio Luigi, Leone, Alessandro, Lupascu, Andrea, Toesca Di Castellazzo, Amelia, Mazza, Andrea, Ponziani, Francesca Romana, Flore, Roberto Antonio, Tondi, Paolo, Massetti, Massimo, Gaudino, Mario (ORCID:0000-0001-7529-438X), Toesca Di Castellazzo, Amelia (ORCID:0000-0001-9817-9421), Ponziani, Francesca Romana (ORCID:0000-0002-5924-6238), Flore, Roberto (ORCID:0000-0003-1659-1338), Tondi, Paolo (ORCID:0000-0003-1654-2448), Massetti, Massimo (ORCID:0000-0002-7100-8478), Gaudino, Mario Fulvio Luigi, Leone, Alessandro, Lupascu, Andrea, Toesca Di Castellazzo, Amelia, Mazza, Andrea, Ponziani, Francesca Romana, Flore, Roberto Antonio, Tondi, Paolo, Massetti, Massimo, Gaudino, Mario (ORCID:0000-0001-7529-438X), Toesca Di Castellazzo, Amelia (ORCID:0000-0001-9817-9421), Ponziani, Francesca Romana (ORCID:0000-0002-5924-6238), Flore, Roberto (ORCID:0000-0003-1659-1338), Tondi, Paolo (ORCID:0000-0003-1654-2448), and Massetti, Massimo (ORCID:0000-0002-7100-8478)
Abstract: OBJECTIVES: To assess the degree of damage to the radial artery (RA) in coronary artery bypass grafting (CABG) patients who underwent preoperative transradial coronary angiography (RA-CA). METHODS: From May 2012 to October 2013, 50 consecutive CABG patients who underwent RA-CA were prospectively enrolled in the study. All patients underwent echo-Doppler evaluation of the RA of the catheterized arm; the contralateral RA was used as control. The distal segment of the RA was submitted to immunohistochemical assessment of endothelial integrity. Patients were divided in three groups according to the time interval from angiography to evaluation: ≤24 h, >24 h to <7 days and ≥7 days. RESULTS: Baseline RA median diameters were 0.25 ± 0.04 cm in the cannulated arm and 0.22 ± 0.04 cm in the non-cannulated arm (P = 0.01). The flow-mediated dilatation (FMD) in the RA in the catheterized arm and in the control arm were 11.6 ± 7.9 and 14.2 ± 8.9 (P = 0.01), respectively. A statistically significant correlation was found between FMD of the catheterized RA and the time from RA-CA (Pearson's r = 0.348). Linear regression analysis confirmed that the FMD of the catheterized RA was dependent on days elapsed from the procedure (P = 0.032; OR 1.11, CI 0.009-0.203). Immunohistochemical evaluation showed extensive endothelial lesion in all examined RAs, with a trend towards reduction of the damage with time. Endothelial function and integrity of the cannulated arm did not reach those of the control arm in any of the study patients. CONCLUSIONS: RA-CA produces extensive damage to the RA. The lesions tend to heal with time but incomplete recovery of endothelial integrity and function is still present more than 30 days after the procedure. After RA-CA, the cannulated RA should not be used for CABG.
Published: 2015

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