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  • Joner, M  (8)
  • Kufner, S  (8)
  • 1
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    P2273Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis
    Oxford University Press (OUP) ; 2018
    In:  European Heart Journal Vol. 39, No. suppl_1 ( 2018-08-01)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 39, No. suppl_1 ( 2018-08-01)
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehy565.P2273
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 2
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    Changes in high-sensitivity troponin according to optical characteristics of neointima and treatment modality of in-stent restenosis
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Vol. 43, No. Supplement_2 ( 2022-10-03)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 43, No. Supplement_2 ( 2022-10-03)
    Abstract: Intravascular imaging studies of native vessel percutaneous coronary intervention (PCI) have shown a relationship between presence of lipid-rich plaques or large necrotic cores and occurrence of periprocedural myocardial injury (PMI). However, limited evidence exists on the relationship between neointimal tissue characteristics, and PMI following PCI of in-stent restenosis (ISR) lesions. Beside neointimal tissue characteristics, treatment modality may represent an additional mechanism influencing PMI in the setting of ISR-PCI. Current ESC guidelines recommend either drug-coated balloon (DCB) or drug-eluting stent (DES) as treatment options for ISR. Purpose To investigate the impact of increasing neointimal inhomogeneity and neoatherosclerotic changes of the neointima, as well as of ISR treatment modality on the occurrence of PMI. Methods Patients with normal or stable/falling increased baseline high-sensitivity troponin T (hs-cTnT) undergoing intravascular optical coherence tomography (OCT) and subsequent DCB or DES treatment of ISR lesions were included. PMI was classified as “minor” or “major” according to the definitions of a recent ESC/EAPCI consensus document. Quadrant-based neointimal characterization was performed at the frame displaying the maximal % area stenosis and the 5 preceding and following analyzed frames. Neointimal tissue was categorized as homogeneous or inhomogeneous, the latter including heterogeneous, layered or neoatherosclerosis quadrants. Hs-cTnT was measured at the time of admission, 3–6 h after PCI, at 6 h intervals in case of rising values, and on a daily basis thereafter. Results Overall, 128 patients were subdivided into low (n=64) and high (n=64) neointimal inhomogeneity groups, based on the median of distribution of non-homogeneous quadrants. No significant between-group differences were detected in terms of hs-cTnT changes (28.0 [12.0–65.8] vs. 25.5 [9.8–65.0] ng/L; p=0.355), or major PMI occurrence (31.2% vs. 31.2%; p=1.000). Similarly, no differences were observed between DCB and DES treated groups in terms of hs-cTnT changes (27.0 [10.0–64.0] vs. 28.0 [11.0–73.0] ng/L; p=0.795), or occurrence of major PMI (28.9% vs. 35.6%; p=0.566). Of note, no significant interaction was observed between optical neointimal characteristics and treatment modality in terms of changes in hs-cTnT (p int = 0.432). There were no significant differences in PMI occurrence between low and high neoatherosclerosis subgroups. Conclusion The present study, which combined a detailed, quadrant-based multi-frame neointimal characterization coupled to systematic pre- and post-procedural hs-cTnT measurements in patients undergoing PCI for ISR, showed no association between increasing neointimal inhomogeneity, or increasing expression of neoatherosclerosis, and occurrence of PMI. PMI occurrence was not influenced by the ISR treatment modality (DCB vs. DES), a finding that supports the safety of DCB treatment for ISR. Funding Acknowledgement Type of funding sources: None.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehac544.2012
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 3
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    Incidence and pattern of repeat coronary revascularizations in patients with acute coronary syndromes treated with ticagrelor or prasugrel
    Oxford University Press (OUP) ; 2023
    In:  European Heart Journal Vol. 44, No. Supplement_2 ( 2023-11-09)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 44, No. Supplement_2 ( 2023-11-09)
    Abstract: The ISAR-REACT 5 randomized trial compared the efficacy and safety of ticagrelor and prasugrel in patients with acute coronary syndromes (ACS) managed invasively. Data are missing with regard to the effect of these antiplatelet agents on the repeat revascularization procedures. Purpose We sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of repeat coronary revascularizations in patients with ACS undergoing percutaneous coronary intervention (PCI). Methods This post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. Patients were divided into two groups as per assigned antiplatelet treatment. The primary outcome for this analysis was the incidence of repeat coronary revascularization (percutaneous or surgical) up to 12-month follow-up. Secondary outcomes were target vessel revascularization (TVR) and non-target vessel revascularization (NTVR). We also studied whether repeat revascularization procedures were urgent in nature. Results Among 3,377 ACS patients, 1,676 were assigned to ticagrelor and 1,701 to prasugrel group before receiving PCI. Compared with prasugrel, the incidence of repeat coronary revascularization at 12 months was significantly higher in patients treated with ticagrelor (hazard ratio [HR]=1.14; 95% confidence interval [CI] 1.01-1.29), mostly attributable to significantly more NTVR (HR=1.15 [1.01-1.32]) in this latter group. There were numerically more urgent repeat revascularizations in patients receiving ticagrelor compared with prasugrel (HR=1.32 [1.00-1.75] ), mostly due to urgent NTVR (HR=1.62 [1.09-2.41]). The risk of TVR was not significantly different between treatment groups (HR=1.04 [0.76-1.44] ). Conclusions In patients with ACS treated with PCI, ticagrelor is associated with significantly more repeat coronary revascularizations compared to prasugrel after 12 months, predominantly in remote coronary vessels.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehad655.1472
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 4
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    Clinical and angiographic outcomes following percutaneous treatment of non-occlusive vs. chronically total occluded coronary lesions
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Vol. 43, No. Supplement_2 ( 2022-10-03)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 43, No. Supplement_2 ( 2022-10-03)
    Abstract: Recent advancements in recanalization techniques, introduction of dedicated equipment and elaboration of systematic algorithmic approaches have significantly improved procedural success of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures. However, despite their undisputable merits in terms of procedural success, direct comparisons of mid-term clinical and angiographic outcomes following CTO and non-CTO-PCI are missing. Purpose The aim of this study was to assess the clinical and angiographic outcomes of patients undergoing successful CTO-PCI as compared to a propensity matched cohort of patients undergoing PCI of non-occlusive coronary lesions. Methods All consecutive patients undergoing successful CTO recanalization procedures at our center between 2015 and 2018 were included (N=453; 472 lesions). For matching purposes, all patients undergoing non-CTO-PCI present in our database were included (N=14733; 23458 lesions). A 1-to-1 nearest neighbour matching using baseline clinical and angiographic variables was performed to identify one patient undergoing non-CTO-PCI (N=453; 472 vessels) for each patient undergoing CTO-PCI (N=453; 472 vessels). Surveillance angiography was scheduled at 6–9 months and clinical follow-up was performed up to 12 months. The primary clinical endpoint of interest was the incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR). The secondary angiographic endpoint was in-segment binary restenosis. Results Patients undergoing CTO-PCI displayed a tendency towards higher degrees of binary restenosis at surveillance angiography as compared to those undergoing non-CTO-PCI (CTO vs. non-CTO: 30.5% vs. 24.0%; P=0.058), despite not meeting statistical significance. Of note, the incidence of occlusive restenosis was low and comparable between groups (2.2% vs. 1.4%; P=0.603). At 12 months follow-up, MACE occurred in 83 patients (19.7%) in the CTO-PCI and 59 patients (14.1%) in the non-CTO-PCI group (hazard ratio [HR] = 1.44; 95% confidence interval [CI]: 1.03–2.01; P=0.033). TLR rates were significantly higher following CTO- as compared to non-CTO-PCI (17.2% vs. 10.3%; HR=1.72 [1.18–2.51] , P=0.005). The incidence of all-cause death (2.6% vs. 3.3%; P=0.548) and MI (0.5% vs. 1.4%; P=0.177) was not significantly different between the groups. Conclusion In this large, propensity-matched comparison of clinical and angiographic outcomes following CTO- vs. non-CTO-PCI, we found CTO-PCI to be associated with a higher MACE rate at 12 months, primarily driven by significantly higher TLR rates. The incidence of occlusive restenosis was low and comparable between groups. Funding Acknowledgement Type of funding sources: None.
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehac544.2073
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 5
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    Ticagrelor or prasugrel in patients with acute coronary syndrome and high bleeding risk
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Vol. 43, No. Supplement_2 ( 2022-10-03)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 43, No. Supplement_2 ( 2022-10-03)
    Abstract: The relative efficacy and safety of more potent P2Y12 inhibitors in patients with acute coronary syndrome (ACS) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear. Purpose To study the treatment effect of ticagrelor and prasugrel in PCI patients presenting with ACS and HBR. Methods This post-hoc analysis of the ISAR-REACT 5 trial included patients with ACS undergoing PCI, randomized to ticagrelor or prasugrel, in whom HBR was defined as per Academic Research Consortium criteria. The primary (efficacy) endpoint was the composite of all-cause death, myocardial infarction, or stroke. The secondary (safety) endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Outcomes were assessed 12 months after randomisation. Results Out of the 3,239 patients included in this analysis, 486 fulfilled the criteria for ARC-HBR definition (HBR group; ticagrelor, n=230 and prasugrel, n=256), whilst 2,753 did not (non-HBR group; ticagrelor, n=1,375 and prasugrel, n=1,378). Compared to the non-HBR group, the HBR group had a higher risk for the primary (hazard ratio [HR]=3.57, 95% confidence interval [CI] , 2.79–4.57, p & lt;0.001), and secondary endpoint (HR=2.94 [2.17–3.99], p & lt;0.001). In the HBR group, the primary (HR=1.09; [0.73–1.62]) and secondary (HR=1.18 [0.67–2.08] ) endpoints were not statistically different between patients assigned to ticagrelor and prasugrel. In the non-HBR group, the primary endpoint (HR=1.62 [1.19–2.20]) occurred more frequently in patients assigned to ticagrelor as compared to patients assigned to prasugrel, without difference in safety (HR=1.08 [0.74–1.58] ). There was no treatment allocation-by-HBR status interaction with respect to the primary (p for interaction = 0.123), or secondary (p for interaction = 0.803) endpoints. Conclusions In patients with ACS undergoing PCI, HBR status increased both ischemic and bleeding risks without significant impact on the relative efficacy or safety of ticagrelor versus prasugrel. These results warrant confirmation in larger cohorts. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehac544.1384
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 6
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    P4559Outcome after single-layer polytetrafluoroethylene-covered stent implantation for the treatment of coronary artery perforation
    Oxford University Press (OUP) ; 2018
    In:  European Heart Journal Vol. 39, No. suppl_1 ( 2018-08-01)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 39, No. suppl_1 ( 2018-08-01)
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehy563.P4559
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 7
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    Ticagrelor or prasugrel in patients with acute coronary syndrome and prior myocardial infarction
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Vol. 43, No. Supplement_2 ( 2022-10-03)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 43, No. Supplement_2 ( 2022-10-03)
    Abstract: To investigate the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) and prior myocardial infarction (MI). Background The efficacy and safety of ticagrelor versus prasugrel in ACS patients with prior MI remains unstudied. Methods Patients with ACS scheduled for an invasive strategy and randomized to ticagrelor or prasugrel in the ISAR-REACT 5 trial with available information concerning prior MI were included in the present analysis. The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Endpoints were assessed 12 months after randomization. Results A total of 4,015 patients were included in this analysis (prior MI= 631 patients; no prior MI = 3,384 patients). As compared to patients without prior MI, the primary endpoint occurred more frequently in patients with prior MI (12.6% vs. 7.2%; hazard ratio [HR] = 1.78, 95% confidence interval [CI] 1.38–2.29; p= & lt;0.001) without significant difference in terms of secondary endpoint between groups (5.8% vs. 5.7%; HR=1.02 [0.71–1.45]; p=0.921). Patients with prior MI randomized to ticagrelor versus prasugrel displayed higher risk for primary (HR=1.62 [1.03–2.55] ) but not secondary endpoint (HR=1.28 [0.56–2.91]). Patients without prior MI randomized to ticagrelor or prasugrel displayed no significant difference in terms of primary (HR=1.28 [0.99–1.65] ) or secondary endpoints (HR=1.13 [0.82–1.55]). There was no treatment assignment-by-prior MI status interaction with respect to the primary (p for interaction = 0.373) and the secondary (p for interaction= 0.786) endpoints. Conclusions Patients with ACS and prior MI are at higher risk for recurrent ischemic but not bleeding events. The history of MI does not affect the relative efficacy and safety of ticagrelor versus prasugrel in patients with ACS. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehac544.1400
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 8
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    Influence of treatment modality and neointimal characteristics on optical coherence tomography on clinical outcomes of in-stent restenosis
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal Vol. 41, No. Supplement_2 ( 2020-11-01)
    Details
    In: European Heart Journal, Oxford University Press (OUP), Vol. 41, No. Supplement_2 ( 2020-11-01)
    Abstract: In-stent restenosis (ISR) represents the more frequent modality of stent failure. The currently recommended treatment strategies are represented by repeat drug-eluting stent (DES) implantation or drug-coated balloon (DCB) angioplasty. Optical coherence tomography can display important information regarding mechanisms of stent failure as well as neointimal characterization. Purpose Aim of the present study was to determine the impact of treatment modality (DES vs. DCB) as well as neointimal characteristics (homogeneous vs. non-homogeneous) as determined by intravascular OCT, on clinical outcomes and explore whether there is an interaction between neointimal pattern of ISR and treatment modality. Methods Patients presenting with ischemic symptoms and/or evidence of myocardial ischemia in three European centers and undergoing intravascular OCT prior to percutaneous coronary intervention (PCI) for ISR, were retrospectively included in this study. Characterization of neointimal tissue was performed at the frame displaying the maximal %AS as well as the 5 preceding and following analyzed frames. Each frame was subdivided in 4 quadrants (90°) and the neointimal characteristics separately characterized for each of them. Based on its optical characteristics, neointimal tissue was categorized as homogeneous, heterogeneous, layered or neoatherosclerosis. Based on the dominant neointimal type, the study population was divided in two groups, (predominantly homogeneous and non-homogeneous). Primary endpoints of the study were represented by major adverse cardiac events (MACE) and its idividual components (death, cardiac death, myocardial infarction and target lesion revascularization (TLR)) at 2 years follow-up. Results A total of 197 patients undergoing OCT prior to PCI for ISR were included in this study. 100 patients were classified as having predominantly homogeneous and 97 as having predominantly non-homogeneous neointima. No association was found between predominant OCT pattern (homogenous vs. non-homogenous) and MACE at 2 years follow-up (HR=1.01, 95% CI: 0.59–1.75; p=0.94), or the individual MACE components. Analogously, no significant differences in terms of MACE at 2 years were found between predominantly homogeneous vs. non-homogeneous neointima in the patient subgroup receiving a DES (p=0.10) and in that undergoing DCB treatment (p=0.11). However, a significant interaction was found between neointimal tissue pattern and treatment modality in terms of MACE (p=0.02) aa well as death or MI (p=0.016). Predominantly non-homogeneous neointima in patients treated with DCB was associated with a higher incidence of MACE. Conclusions Our results indicate that there is a significant interaction between treatment modality of ISR (DES vs. DCB) and neointimal pattern as determined by intravascular OCT. These results land initial support to an OCT-guided treatment of ISR and should be confirmed by larger trials. Funding Acknowledgement Type of funding source: None
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/ehjci/ehaa946.2473
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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