Publications

Incidence of thrombotic stent occlusion during the first three months after sirolimus-eluting stent implantation in 500 consecutive patients

Sirolimus-eluting stents have been used in our institution for all percutaneous interventions, without clinical or anatomic exclusion criteria, as part of the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital registry. We analyzed the incidence of (sub)acute stent thrombosis after sirolimus-eluting stent implantation in an unselected population of 510 consecutive patients. At 3-month follow-up, (sub)acute stent thrombosis was diagnosed in 2 patients (0.4%) 6 hours and 11 days after the procedure, respectively. These cases occurred in diabetic women with complex coronary lesions. Intravascular ultrasound examination showed inadequate stent expansion and uncovered distal dissection as possible mechanical explanations for the thrombosis.

Abstract 2643: The Impact of Gender on the Clinical Outcome after Percutaneous Coronary Revascularization: A Report from the ARTS II Trial

Endothelial Function in Coronary Chronic Total Occlusions

No abstract is provided for this article.

Angiographic-based assessment of microvascular dysfunction: quo vadis?

Intracoronary γ-Radiation Therapy After Angioplasty Inhibits Recurrence in Patients With In-Stent Restenosis

Background —Treatment of in-stent restenosis presents a critical limitation of intracoronary stent implantation. Ionizing radiation has been shown to decrease neointimal formation within stents in animal models and in initial clinical trials. We studied the effects of intracoronary γ-radiation therapy versus placebo on the clinical and angiographic outcomes of patients with in-stent restenosis. Methods and Results —One hundred thirty patients with in-stent restenosis underwent successful coronary intervention and were then blindly randomized to receive either intracoronary γ-radiation with 192 Ir (15 Gy) or placebo. Four independent core laboratories blinded to the treatment protocol analyzed the angiographic and intravascular ultrasound end points of restenosis. Procedural success and in-hospital and 30-day complications were similar among the groups. At 6 months, patients assigned to radiation therapy required less target lesion revascularization and target vessel revascularization (9 [13.8%] and 17 [26.2%], respectively) compared with patients assigned to placebo (41 [63.1%, P =0.0001] and 44 [67.7%, P =0.0001], respectively). Binary angiographic restenosis was lower in the irradiated group (19% versus 58% for placebo, P =0.001). Freedom from major cardiac events was lower in the radiation group (29.2% versus 67.7% for placebo, P <0.001). Conclusions —Intracoronary γ-radiation used as adjunct therapy for patients with in-stent restenosis significantly reduces both angiographic and clinical restenosis.

The Three-mm Ultimate Mopra Milky Way Survey (ThrUMMS): A New View of the Molecular Milky Way

Effects of the Direct Lipoprotein-Associated Phospholipase A ₂ Inhibitor Darapladib on Human Coronary Atherosclerotic Plaque

Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is expressed abundantly in the necrotic core of coronary lesions, and products of its enzymatic activity may contribute to inflammation and cell death, rendering plaque vulnerable to rupture.This study compared the effects of 12 months of treatment with darapladib (an oral Lp-PLA(2) inhibitor, 160 mg daily) or placebo on coronary atheroma deformability (intravascular ultrasound palpography) and plasma high-sensitivity C-reactive protein in 330 patients with angiographically documented coronary disease. Secondary end points included changes in necrotic core size (intravascular ultrasound radiofrequency), atheroma size (intravascular ultrasound gray scale), and blood biomarkers.=0.37). In contrast, Lp-PLA(2) activity was inhibited by 59% with darapladib (P<0.001 versus placebo). After 12 months, there were no significant differences between groups in plaque deformability (P=0.22) or plasma high-sensitivity C-reactive protein (P=0.35). In the placebo-treated group, however, necrotic core volume increased significantly (4.5+/-17.9 mm(3); P=0.009), whereas darapladib halted this increase (-0.5+/-13.9 mm(3); P=0.71), resulting in a significant treatment difference of -5.2 mm(3) (P=0.012). These intraplaque compositional changes occurred without a significant treatment difference in total atheroma volume (P=0.95).Despite adherence to a high level of standard-of-care treatment, the necrotic core continued to expand among patients receiving placebo. In contrast, Lp-PLA(2) inhibition with darapladib prevented necrotic core expansion, a key determinant of plaque vulnerability. These findings suggest that Lp-PLA(2) inhibition may represent a novel therapeutic approach.

Behavior and Design of Normal- and High-Strength Steel SHS and RHS Columns

The behavior and design of hot-rolled and cold-formed steel square and rectangular hollow section (SHS and RHS) columns, made of both normal- and high-strength material, are addressed in this paper. A series of experiments on hot-rolled high-strength steel SHS columns was first conducted—six tests on S690 SHS 100×100×4 columns and six tests on S770 SHS 120×120×6.3 columns were performed. Finite-element (FE) models were developed to replicate the experimental results and to carry out parametric studies to expand the column buckling data pool. The accuracy of the European and North American buckling design rules for normal- and high-strength steel SHS and RHS columns was evaluated through comparisons with the freshly generated test and FE results, as well as with existing test data collected from the literature. Finally, a modified approach was proposed and statistically verified in accordance with existing standards; the new approach features an imperfection factor that is a continuous function of yield strength, reflecting the reducing relative influence of residual stresses and global imperfections with increasing steel grades. Improved consistency in resistance predictions over the existing design provisions is demonstrated across a wide range of steel grades and relative slenderness values.

Neural Control of Airway Function in Asthma

Safety and Efficacy of New-Generation Drug-Eluting Stents in Women at High Risk for Atherothrombosis

Background— The safety and efficacy of new-generation drug-eluting stents (DES) in women with multiple atherothrombotic risk (ATR) factors is unclear. Methods and Results— We pooled patient-level data for women enrolled in 26 randomized trials. Study population was categorized based on the presence or absence of high ATR, which was defined as having history of diabetes mellitus, prior percutaneous or surgical coronary revascularization, or prior myocardial infarction. The primary end point was major adverse cardiovascular events defined as a composite of all-cause mortality, myocardial infarction, or target lesion revascularization at 3 years of follow-up. Out of 10 449 women included in the pooled database, 5333 (51%) were at high ATR. Compared with women not at high ATR, those at high ATR had significantly higher risk of major adverse cardiovascular events (15.8% versus 10.6%; adjusted hazard ratio: 1.53; 95% confidence interval: 1.34–1.75; P =0.006) and all-cause mortality. In high-ATR risk women, the use of new-generation DES was associated with significantly lower risk of 3-year major adverse cardiovascular events (adjusted hazard ratio: 0.69; 95% confidence interval: 0.52–0.92) compared with early-generation DES. The benefit of new-generation DES on major adverse cardiovascular events was uniform between high-ATR and non–high-ATR women, without evidence of interaction ( P interaction =0.14). At landmark analysis, in high-ATR women, stent thrombosis rates were comparable between DES generations in the first year, whereas between 1 and 3 years, stent thrombosis risk was lower with new-generation devices. Conclusions— Use of new-generation DES even in women at high ATR is associated with a benefit consistent over 3 years of follow-up and a substantial improvement in very-late thrombotic safety.

12.08: Cross-section stability of stainless steel channel sections subjected to combined loading

This paper presents a comprehensive experimental and numerical study of the cross-section stability of stainless steel channel sections under combined axial compressive load and major axis bending moment. The experimental investigation included material coupon tests, initial geometric imperfection measurements and eight eccentrically loaded stub column (combined loading) tests, while the numerical modelling programme comprised a valiadtion study and a parametric study to generate further structural performance data. Both the experimental and numerical results were carefully analysed and then used to assess the accuracy of the current Eurocode design provisions for stainless steel channel sections subjected to combined loading. Generally, the Eurocode was found to result in unduly conservative and scattered strength predictions. Improved design rules have been proposed through extension of the deformation-based continuous strength method (CSM) to the case of channel sections under combined loading. Comparisons between the proposal and the test and numerical results indicate a high level of design accuracy and consistency in the predictions. The reliability of the new proposal has also been confirmed by means of statistical analyses according to EN 1990.

Autonomic Factors in Hyperreactivity of Airway Smooth Muscle

Abstract The sections in this article are: Sympathetic Nervous System Sympathetic Innervation Circulating Catecholamines β‐Receptors α‐Receptors Nonadrenergic Inhibitory Nervous System Parasympathetic Nervous System General Considerations Altered Parasympathetic Activity Studies of Asthmatic Patients Conclusion

Ultrasound-guided treatment of acute coronary stent thrombosis

No abstract is provided for this article.

Impact of Lesion Length and Vessel Size on Clinical Outcomes After Percutaneous Coronary Intervention With Everolimus- Versus Paclitaxel-Eluting Stents

Objectives The aim of this study was to investigate the impact of reference vessel diameter (RVD) and lesion length (LL) on the relative safety and efficacy of everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES). Background Lesion length and RVD are well-known predictors of adverse events after percutaneous coronary intervention. Methods Patient-level data were pooled from the randomized SPIRIT (Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System) II, III, IV and COMPARE (Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) trials. Quantitative angiographic core laboratory data were available for 6,183 patients randomized to EES (n = 3,944) or PES (n = 2,239). Long lesions and small vessels were defined as LL >median (13.4 mm) and RVD ≤median (2.65 mm), respectively. Major adverse cardiac events (MACE) (consisting of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed at 2 years, according to stent type in 3 groups: short lesions in large vessels (group A, n = 1,297); long lesions or small vessels but not both (group B, n = 2,981); and long lesions in small vessels (group C, n = 1,905). Results The pooled 2-year MACE rates were 5.6%, 8.2%, and 10.4% in Groups A, B, and C, respectively (p < 0.0001). There was no significant interaction between lesion group and stent type (p = 0.64), indicating lower MACE with EES compared with PES regardless of LL and RVD. However, the absolute difference was largest in Groups B and C. In Group A, 2-year MACE rates were not significantly different between EES and PES (4.8% vs. 7.0%, respectively, p = 0.11). In contrast, EES was associated with lower 2-year rates of MACE in Group B (6.6% vs. 11.2%, p < 0.01) and in Group C (9.1% vs. 12.7%, p = 0.008) as well as lower rates of myocardial infarction, target lesion revascularization, and stent thrombosis. Multivariable analysis confirmed EES versus PES as an independent predictor of freedom from MACE in Groups B and C. Conclusions Patients with short lesions in large vessels have low rates of MACE at 2 years after treatment with either EES or PES. In higher-risk patients with long lesions and/or small vessels, EES results in significant improvements in both clinical safety and efficacy outcomes. (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Patients With de Novo Native Coronary Artery Lesions; NCT00180310; SPIRIT III: A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00180479; SPIRIT IV Clinical Trial: Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT00307047; A Randomized Controlled Trial of Everolimus-eluting Stents and Paclitaxel-eluting Stents for Coronary Revascularization in Daily Practice: The COMPARE Trial; NCT01016041)

Timing and potential mechanisms of new conduction abnormalities during the implantation of the Medtronic CoreValve System in patients with aortic stenosis

New-onset left bundle branch block (LBBB) and complete atrioventricular block (AV3B) frequently occur following transcatheter aortic valve implantation (TAVI). We sought to determine the timing and potential mechanisms of new conduction abnormalities (CAs) during TAVI, using the Medtronic CoreValve System (MCS). Sixty-five consecutive patients underwent TAVI with continuous 12-lead ECG analysis. New CAs were defined by the occurrence of LBBB, RBBB, and/or AV3B after the following pre-defined time points: (i) crossing of valve with stiff wire, (ii) positioning of balloon catheter in the aortic annulus, (iii) balloon valvuloplasty, (iv) positioning of MCS in the left ventricular outflow tract (LVOT), (v) expansion of MCS, (vi) removal of all catheters. A new CA occurred during TAVI in 48 patients (74%) and after TAVI in 5 (8%). Of the 48 patients with procedural CAs, a single new CA occurred in 43 patients (90%) and two types of CAs in 5 (10%). A new LBBB was seen in 40 patients (83%), AV3B in 9 (19%), and RBBB in 4 (8%). The new CA first occurred—in descending order of frequency—after balloon valvuloplasty in 22 patients (46%), MCS expansion in 14 (29%), MCS positioning in 6 (12%), positioning of balloon catheter in 3 (6%), wire-crossing of aortic valve in 2 (4%), and after catheter removal in 1 patient (2%). Patients who developed a new CA during balloon valvuloplasty had a significantly higher balloon/annulus ratio than those who did not (1.10 ± 0.10 vs. 1.03 ± 0.11, P = 0.030). No such relationship was found with the valve/annulus ratio. Transcatheter aortic valve implantation with the MCS was associated with new CAs in 82% of which more than half occurred before the actual valve implantation. It remains to be elucidated by dedicated studies whether new CAs can be reduced by appropriate balloon sizing—a precept that also holds for valve size given the observed directional signal of the valve size/aortic annulus ratio.

Signal Transduction Pathways Involved in Glucocorticoid Actions

First generation versus second generation drug‐eluting stents for the treatment of bifurcations: 5‐year follow‐up of the <scp>LEADERS</scp> all‐comers randomized trial

Historically, percutaneous coronary intervention (PCI) of bifurcation lesions was associated with worse procedural and clinical outcomes when compared with PCI of non-bifurcation lesions. Newer generation drug-eluting stents (DES) might improve long-term clinical outcomes after bifurcation PCI.The LEADERS trial was a 10-center, assessor-blind, non-inferiority, all-comers trial, randomizing 1,707 patients to treatment with a biolimus A9(TM) -eluting stent (BES) with an abluminal biodegradable polymer or a sirolimus-eluting stent (SES) with a durable polymer (ClinicalTrials.gov Identifier: NCT00389220). Five-year clinical outcomes were compared between patients with and without bifurcation lesions and between BES and SES in the bifurcation lesion subgroup. There were 497 (29%) patients with at least 1 bifurcation lesion (BES = 258; SES = 239). At 5-year follow-up, the composite endpoint of cardiac death, myocardial infarction (MI) and clinically-indicated (CI) target vessel revascularization (TVR) was observed more frequently in the bifurcation group (26.6% vs. 22.4%, P = 0.049). Within the bifurcation lesion subgroup, no differences were observed in (cardiac) death or MI rates between BES and SES. However, CI target lesion revascularization (TLR) (10.1% vs. 15.9%, P = 0.0495), and CI TVR (12.0% vs. 19.2%, P = 0.023) rates were significantly lower in the BES group. Definite/probable stent thrombosis (ST) rate was numerically lower in the BES group (3.1% vs. 5.9%, P = 0.15). Very late (>1 year) definite/probable ST rates trended to be lower with BES (0.4% vs. 3.1%, P = 0.057).In the treatment of bifurcation lesions, use of BES led to superior long-term efficacy compared with SES. Safety outcomes were comparable between BES and SES, with an observed trend toward a lower rate of very late definite/probable ST between 1 and 5 years with the BES. © 2015 Wiley Periodicals, Inc.

Iona Opie: distant relations and ‘the kindness of friends’