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Albert Schomig - One of the best experts on this subject based on the ideXlab platform.
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comparison of effects of clopidogrel versus ticlopidine on platelet function in patients undergoing Coronary Stent placement
American Journal of Cardiology, 2001Co-Authors: Meinrad Gawaz, Melchior Seyfarth, Iris Muller, Silja Rudiger, Gisela Pogatsamurray, Beate Wolf, Albert SchomigAbstract:: Clopidogrel in combination with aspirin administered as a loading dose of 450 mg reveals an accelerated antiplatelet effect in the early hours after first administration in patients undergoing Coronary Stent placement.
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effect of a high loading dose of clopidogrel on platelet function in patients undergoing Coronary Stent placement
Heart, 2001Co-Authors: Iris Muller, Albert Schomig, Melchior Seyfarth, Silja Rudiger, Gisela Pogatsamurray, Beate Wolf, Meinrad GawazAbstract:Following Coronary Stent placement, platelet activation is a major determinant of the risk of subacute Stent thrombosis.1 Combined antiplatelet treatment with ticlopidine and aspirin reduced platelet activation after Coronary Stenting1. Although combined antiplatelet treatment consisting of aspirin and ticlopidine has significantly reduced early ischaemic events following Coronary Stenting, Stent thrombosis still occurs in up to 1% of treated patients, especially in the early days after the intervention, probably because of delayed onset of action of ticlopidine. Clopidogrel is a ticlopidine-like novel thienopyridine inhibitor of ADP induced platelet activation.2 Clopidogrel differs from ticlopidine in that it has a favourable safety profile compared to ticlopidine and reveals an accelerated antiplatelet activity after first administration. The present study sought to investigate the antiplatelet effect of various doses of clopidogrel in patients undergoing Coronary Stent placement; comparison was made with standard ticlopidine treatment. Thirty patients were randomised into three treatment arms: group I (n = 10), ticlopidine 2 × 500 g as loading dose and 2 × 250 mg daily thereafter; group II (n = 10), clopidogrel 1 × 300 mg loading dose and 1 × 75 mg per day; or group III (n = 10), clopidogrel 1 × 600 mg plus 2 × 75 mg daily thereafter. All patients received aspirin 2 × 100 mg per day concomitantly. Peripheral venous blood samples were taken with a loose tourniquet through a short venous catheter inserted into a forearm vein before and then 2, …
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influence of lesion length on restenosis after Coronary Stent placement
American Journal of Cardiology, 1999Co-Authors: Adnan Kastrati, Shpend Elezi, Josef Dirschinger, Franz-josef Neumann, Martin Hadamitzky, Albert SchomigAbstract:The length of a Coronary lesion is a significant predictor of restenosis after balloon angioplasty. The influence of lesion length has not comprehensively been assessed after Coronary Stent placement. This study includes 2,736 consecutive patients with Coronary Stent placement. Only patients with recent or chronic occlusions before the intervention were excluded. Patients were divided in 2 groups: 573 patients with long lesions (≥15 mm) and 2,163 patients with short lesions (<15 mm). There were no significant differences between the groups with respect to the procedural success rate and incidence of subacute thrombosis. One-year event-free survival was lower in patients with long lesions (73.3% vs 80.0%, p = 0.001). Six-month angiography was performed in 82.5% of the eligible patients. The incidence of binary restenosis (≥50% diameter stenosis) was higher in patients with long lesions (36.9% vs 27.9%, p <0.001). Similarly, patients with long lesions presented more late lumen loss than those with short lesions (1.29 ± 0.89 vs 1.07 ± 0.77 mm, p <0.001). Multivariate models for both binary restenosis and late lumen loss demonstrated that lesion length was an independent risk factor for restenosis. The risk was further increased by multiple Stent placement and overlapping Stents that were also independent risk factors of restenosis. Stented segment length did not show any independent effect. Therefore, long lesions represent an independent risk factor for restenosis after Coronary Stent placement. The results of this study suggest that a possible way to reduce the risk is to cover the lesion with a minimal number of nonoverlapping Stents.
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PlA Polymorphism of Platelet Glycoprotein IIIa and Risk of Restenosis After Coronary Stent Placement
Circulation, 1999Co-Authors: Adnan Kastrati, Shpend Elezi, Albert Schomig, Melchior Seyfarth, Werner Koch, Corinna Böttiger, Julinda Mehilli, Kathrin Schömig, Nicolas Von BeckerathAbstract:Background—Platelets play a central role in the process of restenosis after percutaneous Coronary interventions. A polymorphism of platelet glycoprotein IIIa (PlA) has been associated with a higher risk of Coronary thrombosis. We designed this prospective study to test the hypothesis that PlA polymorphism of glycoprotein IIIa is associated with an increased risk for restenosis after Coronary Stent placement. Methods and Results—The study included 1150 consecutive patients with successful Coronary Stent placement and 6-month follow-up with Coronary angiography. The end point of the study was the incidence of angiographic restenosis (≥50% diameter stenosis) at follow-up. Of the 1150 patients, 72.5% were homozygous for PlA1, 24.7% were heterozygous (PlA1/A2), and 2.8% were homozygous for PlA2. Patients with the PlA2 allele demonstrated a significantly higher restenosis rate than did those without (47% versus 38%; OR, 1.42; 95% CI, 1.09 to 1.84). The risk was highest in homozygous carriers of PlA2 (53.1% rest...
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Operator volume and outcome of patients undergoing Coronary Stent placement
Journal of the American College of Cardiology, 1998Co-Authors: Adnan Kastrati, Franz-josef Neumann, Albert SchomigAbstract:Abstract Objectives. The aim of this study was to assess the relation between operator experience in Coronary Stent placement procedures and the clinical outcome of patients. Background. The results of Coronary balloon angioplasty are closely related to the experience of the operator performing the procedure. Data on the effect of operator experience on the results after Coronary Stent placement are missing. Methods. The study included 3,409 consecutive patients undergoing Coronary Stent placement for the management of Coronary artery disease. A composite end point of cardiac death, myocardial infarction and aortoCoronary bypass surgery during the first 30 days after the intervention, was the primary end point and the procedural failure was the secondary end point of the study. Results. Adverse clinical outcome occurred in 2.99% of the 3,409 patients undergoing Coronary Stent placement. Procedural failure was recorded in 2.08% of the patients. Operator volumes above 483 procedures were associated with a risk-adjusted adverse outcome rate of 1.70% ± 1.28%, which is significantly lower than the overall rate of 2.99%. Operator yearly volumes of under 90 procedures were associated with a risk-adjusted adverse outcome rate of 4.59% ± 1.17%, which is significantly higher than the overall rate of 2.99%. The operator experience was an independent predictor even after adjusting for the effect of other risk factors. The analysis demonstrated that an experience of at least 100 procedures is required to obtain better outcome even in patients with simple Coronary lesions and that operators should perform at least 70 procedures annually to expect a better outcome in patients with both simple and complex Coronary lesions. Conclusions. Operator experience is a significant and independent predictor of the outcome of patients undergoing Coronary Stent placement. An experience of at least 100 procedures and an annual volume of at least 70 procedures are required to ensure a significantly better outcome after Coronary Stent implantation.
Joachim Schofer - One of the best experts on this subject based on the ideXlab platform.
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tct 460 multi center randomized evaluation of the elixir desyne novolimus eluting Coronary Stent system with biodegradable polymer compared to a zotarolimus eluting Coronary Stent system final 5 year results from the excella bd study
Journal of the American College of Cardiology, 2015Co-Authors: Stefan Verheye, Roberto Botelho, Luiz Fernando Tanajura, Lynn Morrison, Sara Toyloy, Ricardo A. Costa, Peter J. Fitzgerald, Alexandre Abizaid, Katsuhisa Waseda, Joachim SchoferAbstract:A non-inferiority study evaluating the long-term safety and effectiveness of the Elixir DESyne® BD Novolimus Eluting Coronary Stent System (NECSS), a Co-Cr Stent with a biodegradable polymer compared to the control Endeavor Zotarolimus Eluting Coronary Stent System (ZECSS) (Medtronic, Santa Rosa,
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tct 586 multi center prospective randomized single blind consecutive enrollment evaluation of the elixir desyne novolimus eluting Coronary Stent system with biodegradable polymer compared to a zotarolimus eluting Coronary Stent system 3 year results
Journal of the American College of Cardiology, 2014Co-Authors: Stefan Verheye, Roberto Botelho, Lynn Morrison, Sara Toyloy, Ricardo A. Costa, Peter J. Fitzgerald, Alexandre Abizaid, Katsuhisa Waseda, Joachim SchoferAbstract:Evaluate the long-term safety and effectiveness of the Elixir DESyne® BD Novolimus Eluting Coronary Stent System (NECSS), a Co-Cr Stent with a biodegradable polymer compared to the control Endeavor Zotarolimus Eluting Coronary Stent System (ZECSS) (Medtronic, Santa Rosa, CA). 149 patients were
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crt 65 multi center prospective randomized single blind consecutive enrollment evaluation of the elixir desynetm novolimus eluting Coronary Stent system with durable polymer compared to the endeavor zotarolimus eluting Coronary Stent system 3 year cl
Jacc-cardiovascular Interventions, 2013Co-Authors: Alexandre Abizaid, Karl Eugen Hauptmann, Joachim Schofer, John A Ormiston, Jim Stewart, Christophe Dubois, Stefan Verheye, Bernhard Witzenbichler, Karl Stangl, Marcus WiemerAbstract:To evaluate safety and effectiveness of the Elixir DESyneTM Novolimus-Eluting Coronary Stent System (CSS) compared to the Endeavor Zotarolimus-Eluting CSS through assessment of clinical, angiographic, and IVUS endpoints. 210 patients were randomized 2:1 either to the DESyne CSS loaded with 5mcg per
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a randomised comparison of an everolimus eluting Coronary Stent with a paclitaxel eluting Coronary Stent the spirit ii trial
Eurointervention, 2006Co-Authors: Patrick W Serruys, Joachim Schofer, Marcus Wiemer, Peter Ruygrok, Jorg Neuzner, Jan J Piek, Ashok Seth, Gert Richardt, Didier Carrie, Leif ThuesenAbstract:BACKGROUND: Everolimus has been successfully tested in humans using both an erodable and a durable polymer in small previous studies. METHODS: This single blind multi-centre non-inferiority randomised (3:1) controlled trial evaluated the safety and performance of the XIENCE V Everolimus Eluting Coronary Stent System (XIENCE V EECSS) versus the TAXUS Paclitaxel Eluting Coronary Stent System (TAXUS(R) PECSS) in the treatment of patients with a maximum of two de novo native Coronary artery lesions located in two different epicardial vessels. Three hundred patients with evidence of myocardial ischaemia were allocated to Stent implantation with an everolimus-eluting Stent (n=223) or a paclitaxel-eluting Stent (n=77). Suitable lesions had a diameter stenosis of <50-99%, a length of <28 mm, and a reference vessel diameter between 2.5 mm and 4.25 mm. The primary endpoint was in-Stent late loss (LL) at 180 days. Percentage in-Stent volume obstruction (%VO) was measured by intravascular ultrasound (IVUS) in a subset of 152 patients. Clinical secondary endpoints included ischaemia driven major adverse cardiac events (ID-MACE) at 180 days. RESULTS: At 6 months, the in-Stent LL was 0.11+/-0.27 mm in the everolimus-eluting Stent arm, as compared to 0.36+/-0.39 mm in the paclitaxel-eluting Stent arm (p<0.0001). Percentage VO in the everolimus-eluting Stent arm was 2.5+/-4.7% versus 7.4+/-7.0% in the paclitaxel-eluting Stent arm (p<0.0001). Hierarchical MACE was 2.7% (6/222) in the everolimus-eluting Stent arm vs. 6.5% (5/77) in the paclitaxel-eluting Stent arm. CONCLUSION: This non-inferiority randomised trial not only met its primary endpoint, but also demonstrated the superiority of the everolimus-eluting Stent over the paclitaxel-eluting Stent in terms of in-Stent late loss.
Adnan Kastrati - One of the best experts on this subject based on the ideXlab platform.
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influence of lesion length on restenosis after Coronary Stent placement
American Journal of Cardiology, 1999Co-Authors: Adnan Kastrati, Shpend Elezi, Josef Dirschinger, Franz-josef Neumann, Martin Hadamitzky, Albert SchomigAbstract:The length of a Coronary lesion is a significant predictor of restenosis after balloon angioplasty. The influence of lesion length has not comprehensively been assessed after Coronary Stent placement. This study includes 2,736 consecutive patients with Coronary Stent placement. Only patients with recent or chronic occlusions before the intervention were excluded. Patients were divided in 2 groups: 573 patients with long lesions (≥15 mm) and 2,163 patients with short lesions (<15 mm). There were no significant differences between the groups with respect to the procedural success rate and incidence of subacute thrombosis. One-year event-free survival was lower in patients with long lesions (73.3% vs 80.0%, p = 0.001). Six-month angiography was performed in 82.5% of the eligible patients. The incidence of binary restenosis (≥50% diameter stenosis) was higher in patients with long lesions (36.9% vs 27.9%, p <0.001). Similarly, patients with long lesions presented more late lumen loss than those with short lesions (1.29 ± 0.89 vs 1.07 ± 0.77 mm, p <0.001). Multivariate models for both binary restenosis and late lumen loss demonstrated that lesion length was an independent risk factor for restenosis. The risk was further increased by multiple Stent placement and overlapping Stents that were also independent risk factors of restenosis. Stented segment length did not show any independent effect. Therefore, long lesions represent an independent risk factor for restenosis after Coronary Stent placement. The results of this study suggest that a possible way to reduce the risk is to cover the lesion with a minimal number of nonoverlapping Stents.
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PlA Polymorphism of Platelet Glycoprotein IIIa and Risk of Restenosis After Coronary Stent Placement
Circulation, 1999Co-Authors: Adnan Kastrati, Shpend Elezi, Albert Schomig, Melchior Seyfarth, Werner Koch, Corinna Böttiger, Julinda Mehilli, Kathrin Schömig, Nicolas Von BeckerathAbstract:Background—Platelets play a central role in the process of restenosis after percutaneous Coronary interventions. A polymorphism of platelet glycoprotein IIIa (PlA) has been associated with a higher risk of Coronary thrombosis. We designed this prospective study to test the hypothesis that PlA polymorphism of glycoprotein IIIa is associated with an increased risk for restenosis after Coronary Stent placement. Methods and Results—The study included 1150 consecutive patients with successful Coronary Stent placement and 6-month follow-up with Coronary angiography. The end point of the study was the incidence of angiographic restenosis (≥50% diameter stenosis) at follow-up. Of the 1150 patients, 72.5% were homozygous for PlA1, 24.7% were heterozygous (PlA1/A2), and 2.8% were homozygous for PlA2. Patients with the PlA2 allele demonstrated a significantly higher restenosis rate than did those without (47% versus 38%; OR, 1.42; 95% CI, 1.09 to 1.84). The risk was highest in homozygous carriers of PlA2 (53.1% rest...
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Operator volume and outcome of patients undergoing Coronary Stent placement
Journal of the American College of Cardiology, 1998Co-Authors: Adnan Kastrati, Franz-josef Neumann, Albert SchomigAbstract:Abstract Objectives. The aim of this study was to assess the relation between operator experience in Coronary Stent placement procedures and the clinical outcome of patients. Background. The results of Coronary balloon angioplasty are closely related to the experience of the operator performing the procedure. Data on the effect of operator experience on the results after Coronary Stent placement are missing. Methods. The study included 3,409 consecutive patients undergoing Coronary Stent placement for the management of Coronary artery disease. A composite end point of cardiac death, myocardial infarction and aortoCoronary bypass surgery during the first 30 days after the intervention, was the primary end point and the procedural failure was the secondary end point of the study. Results. Adverse clinical outcome occurred in 2.99% of the 3,409 patients undergoing Coronary Stent placement. Procedural failure was recorded in 2.08% of the patients. Operator volumes above 483 procedures were associated with a risk-adjusted adverse outcome rate of 1.70% ± 1.28%, which is significantly lower than the overall rate of 2.99%. Operator yearly volumes of under 90 procedures were associated with a risk-adjusted adverse outcome rate of 4.59% ± 1.17%, which is significantly higher than the overall rate of 2.99%. The operator experience was an independent predictor even after adjusting for the effect of other risk factors. The analysis demonstrated that an experience of at least 100 procedures is required to obtain better outcome even in patients with simple Coronary lesions and that operators should perform at least 70 procedures annually to expect a better outcome in patients with both simple and complex Coronary lesions. Conclusions. Operator experience is a significant and independent predictor of the outcome of patients undergoing Coronary Stent placement. An experience of at least 100 procedures and an annual volume of at least 70 procedures are required to ensure a significantly better outcome after Coronary Stent implantation.
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bimodal distribution of angiographic measures of restenosis six months after Coronary Stent placement
Circulation, 1997Co-Authors: Albert Schomig, Shpend Elezi, Felix Dannegger, Josef Dirschinger, Helmut Schuhlen, Adnan Kastrati, Manfred G WilhelmAbstract:Background Restenosis has been perceived as the tail end of a normal distribution of the response of the vessel to the intervention. However, recent studies have described a bimodal distribution for de novo lesions after percutaneous transluminal Coronary angioplasty. This finding suggests that some lesions may be more susceptible for restenosis. Whether this holds true for a wider spectrum of lesions undergoing Stent placement is not yet known. The present study analyzes the frequency distribution of angiographic indexes of restenosis 6 months after Coronary Stent implantation. Methods and Results Quantitative angiographic evaluation was performed in 1084 lesions of 1084 patients before, immediately after, and 6 months after successful Palmaz-Schatz Stent placement; this represented 80.4% of patients eligible for follow-up angiography. Principal end points of the analysis were angiographic indexes of restenosis at 6 months. Twenty-two lesions that became totally occluded at follow-up were excluded from most parts of the analysis. Diameter stenosis, minimal luminal diameter (MLD), and lumen loss at 6 months did not follow a normal pattern; the bimodal pattern was demonstrated through deconvolution that yielded two separate normal components delineating two lesion populations, which developed distinctively different degrees of lumen renarrowing. The first and larger subgroup of lesions, which was less prone to restenosis, was centered around a mean value of 27% for diameter stenosis and 2.19 mm for MLD, whereas the second subgroup, with a greater tendency for restenosis, was situated around a mean value of 68% for diameter stenosis and 0.76 mm for MLD. The intersection point between the two theoretical normal distribution components was 53.5% for diameter stenosis and 1.09 mm for MLD at follow-up. Conclusions Frequency-distribution curves of angiographic indexes of restenosis after Coronary Stent placement have a bimodal pattern, suggesting the existence of two distinct populations with different propensity to restenosis. These findings may encourage future efforts for the timely identification of the subset with a higher risk as the target of specific antirestenotic strategies.
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predictive factors of restenosis after Coronary Stent placement
Journal of the American College of Cardiology, 1997Co-Authors: Adnan Kastrati, Shpend Elezi, Josef Dirschinger, Helmut Schuhlen, Albert Schomig, Martin Hadamitzky, Anne Wehinger, Jorg Hausleiter, Hanna Walter, Franz-josef NeumannAbstract:Abstract Objectives. The objective of this study was to identify clinical, lesional and procedural factors that can predict restenosis after Coronary Stent placement. Background. Coronary Stent placement reduces the restenosis rate compared with that after percutaneous transluminal Coronary angioplasty (PTCA). However, restenosis remains an unresolved issue, and identification of its predictive factors may allow further insight into the underlying process. Methods. All patients with successful Coronary Stent placement were eligible for this study unless they had had a major adverse cardiac event during the 1st 30 days after the procedure. Of the 1,349 eligible patients (1,753 lesions), follow-up angiography at 6 months was performed in 80.4% (1,084 patients, 1,399 lesions). Demographic, clinical, lesional and procedural data were prospectively recorded and analyzed for any predictive power for the occurrence of late restenosis after Stenting. Restenosis was evaluated by using three outcomes at follow-up: binary restenosis as a diameter stenosis ≥50%, late lumen loss as lumen diameter reduction and target lesion revascularization (TLR) as any repeat PTCA or Coronary artery bypass surgery involving the Stented lesion. Results. Multivariate analysis demonstrated that diabetes mellitus, placement of multiple Stents and minimal lumen diameter (MLD) immediately after Stenting were the strongest predictors of restenosis. Diabetes increased the risk of binary restenosis with an odds ratio (OR) [95% confidence interval] of 1.86 [1.56 to 2.16] and the risk of TLR with an OR of 1.45 [1.11 to 1.80]. Multiple Stents increased the risk of binary restenosis with an OR of 1.81 [1.55 to 2.06] and that of TLR with an OR of 1.94 [1.66 to 2.22]. An MLD Conclusions. Diabetes, multiple Stents and smaller final MLD are strong predictors of restenosis after Coronary Stent placement. Achieving an optimal result with a minimal number of Stents during the procedure may significantly reduce this risk even in patients with adverse clinical characteristics such as diabetes.
Meinrad Gawaz - One of the best experts on this subject based on the ideXlab platform.
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low response to clopidogrel is associated with cardiovascular outcome after Coronary Stent implantation
European Heart Journal, 2006Co-Authors: Tobias Geisler, Harald F Langer, Magdalena Wydymus, Katrin Gohring, Christine Zurn, Boris Bigalke, Konstantinos Stellos, Andreas E May, Meinrad GawazAbstract:Aims To assess whether low response to clopidogrel influences cardiovascular outcome after Coronary Stent implantation in a consecutively measured cohort of patients with Coronary Stent implantation. Methods and results A total of 379 consecutive patients with symptomatic Coronary artery disease (CAD), (stable angina n =206 and acute Coronary syndrome, n =173) treated with percutaneous Coronary Stenting were enrolled in this trial. Responsiveness to clopidogrel was assessed by ADP (20 µmol/L)-induced aggregometry at least 6 h (mean 34.8±25.9 h) after administration of a loading dose of 600 mg clopidogrel. Platelet inhibition <30% was defined as low response to clopidogrel. At 3-month follow-up, the primary outcome of a combined major cardiovascular event including non-fatal myocardial infarction, non-fatal ischaemic stroke, or cardiovascular death was evaluated. Twenty-two patients (5.8%) were classified as low responders. Compared with patients who adequately responded to clopidogrel, a low responder had a significantly higher risk of major cardiovascular events [22.7 vs. 5.6%; odds ratio, 4.9; 95% confidence interval (CI), 1.66–14.96; P =0.004]. After adjustment for other factors influencing cardiovascular outcome, low response to clopidogrel and severe left ventricular dysfunction were independently associated with a major cardiovascular event within 3 months (hazard ratio for low response to clopidogrel, 3.71; 95% CI, 1.08–12.69; P =0.037). Conclusion Low response to clopidogrel in patients with symptomatic CAD treated by Stenting significantly enhances the occurrence of cardiovascular events and death. The evaluation of low response to clopidogrel may help to identify patients at increased risk who may benefit from intensified antiplatelet strategy.
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comparison of effects of clopidogrel versus ticlopidine on platelet function in patients undergoing Coronary Stent placement
American Journal of Cardiology, 2001Co-Authors: Meinrad Gawaz, Melchior Seyfarth, Iris Muller, Silja Rudiger, Gisela Pogatsamurray, Beate Wolf, Albert SchomigAbstract:: Clopidogrel in combination with aspirin administered as a loading dose of 450 mg reveals an accelerated antiplatelet effect in the early hours after first administration in patients undergoing Coronary Stent placement.
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effect of a high loading dose of clopidogrel on platelet function in patients undergoing Coronary Stent placement
Heart, 2001Co-Authors: Iris Muller, Albert Schomig, Melchior Seyfarth, Silja Rudiger, Gisela Pogatsamurray, Beate Wolf, Meinrad GawazAbstract:Following Coronary Stent placement, platelet activation is a major determinant of the risk of subacute Stent thrombosis.1 Combined antiplatelet treatment with ticlopidine and aspirin reduced platelet activation after Coronary Stenting1. Although combined antiplatelet treatment consisting of aspirin and ticlopidine has significantly reduced early ischaemic events following Coronary Stenting, Stent thrombosis still occurs in up to 1% of treated patients, especially in the early days after the intervention, probably because of delayed onset of action of ticlopidine. Clopidogrel is a ticlopidine-like novel thienopyridine inhibitor of ADP induced platelet activation.2 Clopidogrel differs from ticlopidine in that it has a favourable safety profile compared to ticlopidine and reveals an accelerated antiplatelet activity after first administration. The present study sought to investigate the antiplatelet effect of various doses of clopidogrel in patients undergoing Coronary Stent placement; comparison was made with standard ticlopidine treatment. Thirty patients were randomised into three treatment arms: group I (n = 10), ticlopidine 2 × 500 g as loading dose and 2 × 250 mg daily thereafter; group II (n = 10), clopidogrel 1 × 300 mg loading dose and 1 × 75 mg per day; or group III (n = 10), clopidogrel 1 × 600 mg plus 2 × 75 mg daily thereafter. All patients received aspirin 2 × 100 mg per day concomitantly. Peripheral venous blood samples were taken with a loose tourniquet through a short venous catheter inserted into a forearm vein before and then 2, …
David R Holmes - One of the best experts on this subject based on the ideXlab platform.
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perioperative cardiovascular risk of prior Coronary Stent implantation among patients undergoing noncardiac surgery
Journal of the American College of Cardiology, 2016Co-Authors: Karim D. Mahmoud, Ryan J. Lennon, Saurabh Sanon, Elizabeth B Habermann, Kristine M Thomsen, Douglas L Wood, Felix Zijlstra, Robert L Frye, David R HolmesAbstract:Abstract Background Previous studies have observed high rates of perioperative cardiovascular events in patients with Coronary Stents undergoing noncardiac surgery (NCS). It is uncertain whether this finding reflects an independent association. Objectives The goal of this study was to assess the independent relationship between prior Coronary Stent implantation and the occurrence of perioperative major adverse cardiac and cerebrovascular events (MACCE) and bleeding and its relation with time from Stenting to NCS. Methods A total of 24,313 NCS cases at the Mayo Clinic (Rochester, Minnesota) from 2006 through 2011 were included in the study; 1,120 (4.6%) cases involved patients with Coronary Stents. MACCE was defined as death, myocardial infarction, cardiac arrest, or stroke. Age-adjusted odds ratios (aORs) were calculated after propensity adjustment for Revised Cardiac Risk Index factors and other conventional risk factors. Results The 30-day MACCE rates were 3.7% and 1.5% in Stented and unStented patients, respectively (p 1 month after Stent implantation was not limited to only those with drug-eluting Stents. Conclusions This study found that prior Coronary Stent implantation is an independent risk factor for MACCE and bleeding when time from Stenting to NCS is
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Circadian Variation in Coronary Stent Thrombosis
JACC. Cardiovascular interventions, 2011Co-Authors: Karim D. Mahmoud, Charanjit S Rihal, Ryan J. Lennon, Henry H. Ting, David R HolmesAbstract:Objectives We sought to determine the circadian, weekly, and seasonal variation of Coronary Stent thrombosis. Background Other adverse cardiovascular events such as acute myocardial infarction are known to have higher incidences during the early morning hours, Mondays, and winter months. Methods The Mayo Clinic Percutaneous Coronary Intervention Registry was searched for patients admitted to our center who underwent repeat percutaneous Coronary intervention in a previously Stented Coronary artery segment. Stent thrombosis was confirmed by angiographic review, and date and time of symptom onset were obtained from medical records. Results We identified 124 patients with definite Stent thrombosis and known date and time of symptom onset. In these patients, onset of Stent thrombosis was significantly associated with time of day (p = 0.006), with a peak incidence around 7:00 am . When patients were subdivided into early Stent thrombosis (0 to 30 days; n = 49), late Stent thrombosis (31 to 360 days; n = 30), and very late Stent thrombosis (>360 days; n = 45), only early Stent thrombosis remained significantly associated with time of day (p = 0.030). No association with the day of the week was found (p = 0.509); however, onset of Stent thrombosis did follow a significant seasonal pattern, with higher occurrences in the summer (p = 0.036). Conclusions Coronary Stent thrombosis occurs more often in the early morning hours. Early Stent thrombosis follows a circadian rhythm with a peak at 7:00 am . This pattern was not significant in late and very late Stent thrombosis. Occurrences throughout the week were equally distributed, but Stent thrombosis was more likely to occur in the summer months.
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Coronary Stent restenosis in patients treated with cilostazol
Circulation, 2005Co-Authors: John S Douglas, David R Holmes, Dean J Kereiakes, Cindy L Grines, Elizabeth H Block, Ziyad M B Ghazzal, Douglas C Morris, Henry A Liberman, Karen M Parker, Claudine JurkovitzAbstract:Background— Restenosis after implantation of Coronary artery Stents remains a significant clinical problem. We undertook a randomized, double-blind, placebo-controlled trial to determine whether cilostazol, a drug that suppresses intimal proliferation, would reduce renarrowing in patients after Stent implantation in native Coronary arteries. Methods and Results— We assigned 705 patients who had successful Coronary Stent implantation to receive, in addition to aspirin, cilostazol 100 mg BID or placebo for 6 months; clopidogrel 75 mg daily was administered to all patients for 30 days. Restenosis was determined by quantitative Coronary angiography at 6 months. The minimal luminal diameter at 6 months for cilostazol-treated patients was 1.77 mm for the analysis segment (Stent plus 5-mm borders) compared with 1.62 mm in the placebo group (P=0.01). Restenosis, defined as ≥50% narrowing, occurred in 22.0% of patients in the cilostazol group and in 34.5% of the placebo group (P=0.002), a 36% relative risk reducti...
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frequency and correlates of Coronary Stent thrombosis in the modern era analysis of a single center registry
Journal of the American College of Cardiology, 2002Co-Authors: James L Orford, Malcolm R Bell, Charanjit S Rihal, David R Holmes, Ryan J. Lennon, Steven Melby, Panayotis Fasseas, Peter B BergerAbstract:OBJECTIVES The study examined the frequency, correlates, and outcome of patients with Stent thrombosis within 30 days of Stent placement. BACKGROUND Patients in trials evaluating Stents or dual antiplatelet therapy to prevent Coronary Stent thrombosis have generally had narrow inclusion criteria; the extent to which Stent thrombosis rates in such trials represent current practice, particularly with the availability of newer Stents, is unclear. METHODS We performed a retrospective analysis of the Mayo Clinic Percutaneous Coronary Intervention database and identified all patients who received at least one Coronary Stent and dual antiplatelet therapy (aspirin and ticlopidine or clopidogrel for two to four weeks). RESULTS Four thousand five hundred nine patients underwent successful Coronary Stent implantation and were treated with dual antiplatelet therapy between July 1, 1994, and April 30, 2000. Stent thrombosis occurred in 23 patients (0.51%; 95% confidence interval 0.32%, 0.76%) within 30 days of Stent placement. Multivariate analysis using bootstrap model selection to avoid over-fitting the model indicated that only the number of Stents placed was an independent correlate of Stent thrombosis (odds ratio 1.80, p < 0.001). The frequency of death and frequency of nonfatal myocardial infarction (MI) among the 23 patients with Stent thrombosis were 48% and 39%, respectively. CONCLUSIONS Stent thrombosis is even more rare in the current era than in earlier trials. Number of Stents placed was an independent correlate of Stent thrombosis. Most patients who suffer Stent thrombosis either die or suffer MI.
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timing of Coronary Stent thrombosis in patients treated with ticlopidine and aspirin
American Journal of Cardiology, 1999Co-Authors: Stephanie H Wilson, Malcolm R Bell, James L Velianou, Charanjit S Rihal, David R Holmes, Peter B BergerAbstract:In patients receiving Coronary Stents treated with aspirin and coumadin, the peak incidence of Stent thrombosis occurs on the fifth and sixth days following the implantation procedure. Little is known about the timing of Stent thrombosis in patients treated with aspirin and ticlopidine. We compared the timing of Coronary Stent thrombosis in patients treated with ticlopidine and aspirin with the timing in those receiving coumadin and aspirin. A retrospective databank analysis was performed and 39 patients were identified who experienced Stent thrombosis after successful Coronary Stent implantation. Of these, 21 had been treated with ticlopidine and aspirin and 18 with coumadin and aspirin therapy. The median time from Stent implantation to Stent thrombosis in the ticlopidine and aspirin group was 12 hours (interquartile range 6 to 72 hours) compared with 4 days in the coumadin and aspirin group (interquartile range 21 to 68 hours) (p <0.0001). There was no significant difference between the timing of Stent thrombosis in patients treated with abciximab in addition to ticlopidine and aspirin (median 17 hours, interquartile range 6 to 29) versus ticlopidine and aspirin patients who did not receive abciximab (median 11 hours, interquartile range 9 to 12, p = 0.57). Thus, in patients who receive Coronary Stents, Stent thrombosis occurs much earlier after the procedure in patients treated with ticlopidine and aspirin than in patients treated with anticoagulation therapy.