Publications

Objective: Everolimus-eluting stents (EES) have been shown to be more effective than Paclicaxel-eluting stent (PES) in the context of randomized trials with selected patients. However, the comparat...

Objective To optimize the predictive value of cardiac magnetic resonance imaging (MRI) for improvement of myocardial dysfunction prior to percutaneous coronary intervention (PCI). Methods We performed cardiac MRI in 72 patients (male 87%, age 60years) before and 6months after successful PCI (43/72) or unsuccessful PCI (29/72) of a chronic total coronary occlusion (CTO). Before PCI, 5 viability parameters were evaluated: transmural extent of infarction (TEI), contractile reserve during dobutamine, end diastolic wall thickness, unenhanced rim thickness and segmental wall thickening of the unenhanced rim (SWTur). Multivariate analysis was performed and based on the regression coefficient (RC) a predictive score was constructed. Diagnostic performance to predict improvement in myocardial function for each parameter and for the viability score was determined. Results The predictive value of a combination of contractile reserve, SWTur and TEI was incremental to TEI alone (AUROC 0.91 vs. 0.77; p<0.001). A viability score of ≥5 based on contractile reserve (RC=4), SWTur (RC=1) and TEI (RC=2) was 91% sensitive and 84% specific in predicting improvement of myocardial function. Conclusion Combining viability parameters results in a better prediction of improvement of dysfunctional myocardial segments after a successful PCI.

No abstract is provided for this article.

Percutaneous coronary angioscopy was used in 13 patients in a pilot study to assess the intracoronary changes that occur during the first hour after balloon angioplasty (PTCA). The dilated segment was studied with 4.5F angioscopes and with quantitative coronary angiography (QCA) immediately after PTCA and at 15-minute intervals for up to 1 hour after PTCA. Significant progression of intimal dissection and thrombus formation could be demonstrated with angioscopy. These dissections and thrombi remained undetected with angiography, which only showed haziness. Thus through its superior sensitivity to intimal damage and thrombus, coronary angioscopy can reveal important intravascular events that apparently occur even after successful PTCA. The relation of such angioscopic observations to restenosis will be addressed in a subsequent multicenter study.

Background The dual antiplatelet therapy (DAPT) score, one of the first prediction tools to attempt to uncouple bleeding and ischemic risk following percutaneous coronary intervention, can help guide antiplatelet duration after coronary intervention. Evaluating the generalizability of the score is important to understand its utility in clinical practice. Methods We conducted a systematic review and meta‐analysis of studies that validated the DAPT score. A random effect meta‐analysis was performed of ischemic and bleeding risk based on DAPT score. A secondary analysis assessed the risk of longer versus shorter P2Y 12 inhibitor duration on ischemic and bleeding risk in randomized controlled trials of DAPT duration. Results We identified 10 patient cohorts involving 88,563 patients. Compared with a low DAPT score, a high DAPT score was associated with increased ischemic risk (RR: 1.62, 95% CI: 1.41–1.87) and reduced bleeding risk (RR: 0.80, 95% CI: 0.70–0.92). In three randomized trials of DAPT duration that contained information on the DAPT score, the relative risk of net adverse clinical events (combined ischemic and bleeding events) with longer duration of DAPT was 1.56 (95% CI: 0.77–3.19) for low DAPT score patients, and 0.86 (95% CI: 0.61–1.21) for high DAPT score patients ( p interaction = .14). Conclusions In this large meta‐analysis, the DAPT score consistently stratified bleeding and ischemic risk in opposing directions across several different study populations. More evaluation is needed to understand if the effect of longer DAPT duration on NACE is modified by the DAPT score in current practice.

No abstract is provided for this article.

Objective We examined whether anxiety has incremental value to depressive symptoms in predicting health status in patients undergoing percutaneous coronary intervention (PCI) treated in the drug-eluting stent era. Methods A series of consecutive patients (n=692) undergoing PCI as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital registry completed the Hospital Anxiety and Depression Scale at 6 months and the Short-Form Health Survey (SF-36) at 6 and 12 months post-PCI. Results Of 692 patients, 471 (68.1%) had no symptoms of anxiety nor depression, 62 (9.0%) had anxiety only, 59 (8.5%) had depressive symptoms only, and 100 (14.5%) had co-occurring symptoms. There was an overall significant improvement in health status between 6 and 12 months post-PCI (P<.001); the interaction effect for time by psychological symptoms was also significant (P=.003). Generally, patients with co-occurring symptoms reported significantly poorer health status compared with the other three groups (Ps <.001). Patients with co-occurring symptomatology were also at greater risk of impaired health status on six of the eight subdomains of the SF-36 compared with the other three symptom groups, adjusting for baseline characteristics and health status at 6 months. Conclusion Patients with co-occurring symptoms of anxiety and depression reported poorer health status compared with anxious or depressed-only patients and no-symptom patients, showing that anxiety has incremental value to depressive symptoms in identifying PCI patients at risk for impaired health status treated in the drug-eluting stent era.

This study sought to investigate the long-term clinical outcomes related to scaffold sizing based on quantitative coronary angiography.A total of 1,248 patients who received Absorb bioresorbable scaffolds in the ABSORB Cohort B, ABSORB EXTEND, and ABSORB II trials were included in the analysis. The incidence of MACE (a composite of cardiac death, any myocardial infarction [MI], and ischaemia-driven target lesion revascularisation [ID-TLR]) was analysed according to the Dmax subclassification of oversized scaffold group versus non-oversized (any undersize) scaffold group. At three years, event rates were similar in both groups in MACE (9.4% vs. 9.8%, p=0.847), target vessel MI (5.2% vs. 4.8%, p=0.795), and ID-TLR (4.8% vs. 5.8%, p=0.445). Landmark analysis after one year showed that the non-oversized scaffold group had higher rates of MACE (3.2% vs. 6.9%, log-rank p=0.004), target vessel MI (0.7% vs. 2.7%, log-rank p=0.007), and ID-TLR (2.5% vs. 4.7%, log-rank p=0.041).Implantation of an undersized scaffold was associated with a higher risk of MACE between one and three years, while in the previous report an oversized scaffold was associated with a higher risk of MACE up to one year. This implies different mechanisms for early and late events after scaffold implantation.

In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients. This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD. Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause. The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001). CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.

Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization. Background Noninvasive MSCT coronary angiography is a promising coronary imaging technique. Methods Sixteen-row MSCT coronary angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with stable angina pectoris scheduled for conventional coronary angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative coronary angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as <50% obstructions. All patients with and 86% (18 of 21) of patients without significant lesions on QCA were correctly classified by MSCT. All patients with significant left main disease or total occlusions were correctly identified on MSCT. Conclusions Sixteen-row MSCT coronary angiography permits reliable detection of significant obstructive coronary artery disease in patients with stable angina in sinus rhythm.

ABSTRACT We present a robust, long-range optical autofocus system for microscopy utilizing machine learning. This can be useful for experiments with long image data acquisition times that may be impacted by defocusing resulting from drift of components, e.g. due to changes in temperature or mechanical drift. It is also useful for automated slide scanning or multiwell plate imaging where the sample(s) to be imaged may not be in the same horizontal plane throughout the image data acquisition. To address the impact of (thermal or mechanical) fluctuations over time in the optical autofocus system itself, we utilise a convolutional neural network (CNN) that is trained over multiple days to account for such fluctuations. To address the trade-off between axial precision and range of the autofocus, we implement orthogonal optical readouts with separate CNN training data, thereby achieving an accuracy well within the 600 nm depth of field of our 1.3 numerical aperture objective lens over a defocus range of up to approximately +/− 100 μm. We characterise the performance of this autofocus system and demonstrate its application to automated multiwell plate single molecule localisation microscopy.