TCT-386 Global risk score for choosing the best revascularization strategy in patients with unprotected left main stenosis

Modernista, 1920.Primer pla d'edifici unifamiliar.De planta baixa, planta semisoterrani i un cos de garatge adossat.Les obertures situen a les llindes uns motllurats i sinuosos motius escultòrics. Un element de ceràmica divideix els baixos del coronament

Coronary Endothelium‐Dependent Vasomotor Function After Drug‐Eluting Stent and Bioresorbable Scaffold Implantation

Infarto de miocardio; Disfunción endotelial; Tomografía de coherencia ópticaMyocardial infarction; Endothelial dysfunction; Optical coherence tomographyInfart de miocardi; Disfunció endotelial; Tomografia de coherència òpticaBackground Early generation drug‐eluting stents (DESs) showed a high grade of coronary endothelial dysfunction that was attributed to lack of stent reendothelialization. Endothelium‐dependent vasomotor response of current DESs and bioresorbable scaffolds (BRSs) remains unknown. This study sought to assess the device‐related endothelial function of current devices and to correlate neointima healing with endothelial function. Methods and Results A total of 206 patients from 4 randomized trials treated with the durable‐polymer everolimus‐eluting Xience (n=44), bioresorbable‐polymer sirolimus‐eluting Orsiro (n=35), polymer‐free biolimus‐eluting Biofreedom (n=24), bioactive endothelial‐progenitor cell‐capturing sirolimus‐eluting Combo DES (n=25), polymer‐based everolimus‐eluting Absorb (n=44), and Mg‐based sirolimus‐eluting Magmaris BRS (n=34) underwent endothelium‐dependent vasomotor tests and optical coherence tomography imaging, as per protocol, at follow‐up. Crude vasomotor responses of distal segments to low‐dose acetylcholine (10−6 mol/L) were different between groups: bioresorbablepolymer DEShad the worst (−8.4%±12.6%) and durable‐polymer DES had the most physiologic (−0.4%±11.8%; P=0.014). High‐dose acetylcholine (10−4 mol/L) showed similar responses between groups (ranging from −10.8%±11.6% to −18.1%±15.4%; P=0.229). Device healing was different between devices. Uncovered struts ranged from 6.3%±7.1% (bioresorbable‐polymer DES) to 2.5%±4.5% (bioactive DES; P=0.056). In multivariate models, endothelium‐dependent vasomotor response was associated with age, bioresorbable‐polymer DES, and angiographic lumen loss, but not with strut coverage nor plaque type. Endothelial dysfunction (defined as ≥4% vasoconstriction) was observed in 46.6% of patients with low‐dose and 68.9% with high‐dose acetylcholine, without differences between groups. Conclusions At follow‐up, endothelial dysfunction was frequently observed in distal segments treated with current stents without remarkable differences between devices. Although neointima healing was different between devices, poor healing was not associated with endothelial dysfunction.The source funding of the 4 randomized trials included in this study is the following. The BVS‐FLOW trial (Coronary vasomotor function and myocardial flow with bioresorbable vascular scaffolds or everolimus‐eluting metallic stents: a randomised trial) was funded by a grant of “La Marato” Foundation. The Spanish Heart Foundation funded the RE‐TROFI2 (Long‐Term Coronary Functional Assessment of the Infarct‐Related Artery Treated With Everolimus‐Eluting Bioresorbable Scaffolds or Everolimus‐Eluting Metallic Stents: Insights of the TROFI II Trial) and MAGSTEMI (Magnesium‐Based Resorbable Scaffold Versus Permanent Metallic Sirolimus‐Eluting Stent in Patients With ST‐Segment Elevation Myocardial Infarction) trials. The FUNCOMBO (Coronary endothelial and microvascular function distal to polymer‐free and endothelial cell‐capturing drug‐eluting stents) trial was funded by OrbusNeich and was promoted by the Spanish Heart Foundation

Antiplatelet efficacy of ticagrelor versus clopidogrel in Mediterranean patients with diabetes mellitus and chronic coronary syndromes: A crossover pharmacodynamic investigation

IntroductionPatients with diabetes mellitus (DM) have augmented platelet reactivity and diminished responsiveness to clopidogrel. Ticagrelor, a more potent P2Y(12) inhibitor, is clinically superior to clopidogrel in acute coronary syndromes, although its role in chronic coronary syndromes (CCS) is still the subject of debate. The aim of this investigation was to compare the pharmacodynamic effectiveness of ticagrelor and clopidogrel in Mediterranean DM patients with CCS.Materials and methodsIn this prospective, randomized, crossover study, patients (n = 20) were randomized (1:1) to receive, on top of aspirin therapy, either ticagrelor 180 mg loading dose (LD)/90 mg maintenance dose (MD) b.i.d. or clopidogrel 600 mg LD/75 mg MD o.d. for 1 week in a crossover fashion with a 2-4 week washout period between regimens. Platelet function measurements were performed at 4 timepoints in each period (baseline, 2 h and 24 h after LD, and 1 week), including light transmission aggregometry (LTA, primary endpoint), VASP assay, Multiplate and VerifyNow P2Y(12).ResultsThe ticagrelor LD achieved greater platelet inhibitory effect than clopidogrel LD, assessed with LTA (20 mu M ADP as agonist), at 2 h (34.9 & PLUSMN; 3.9% vs. 63.6 & PLUSMN; 3.9%; p < 0.001) and 24 h (39.4 & PLUSMN; 3.5% vs. 52.3 & PLUSMN; 3.8%; p = 0.014). After 1 week of therapy, platelet reactivity was again significantly inferior with ticagrelor compared to clopidogrel (30.7 & PLUSMN; 3.0% vs. 54.3 +/- 3.0%; p < 0.001). The results were consistent with the other platelet function assays employed.ConclusionIn Mediterranean patients with DM and CCS, ticagrelor provides a more potent antiplatelet effect than clopidogrel after the LD and during the maintenance phase of therapy

Reproducibility of Intravascular Ultrasound iMAP for Radiofrequency Data Analysis: Implications for Design of Longitudinal Studies

Background: iMAP is a new intravascular ultrasound (IVUS) derived technique for tissue characterization using spectral analysis. Since there is a need for reproducibility data to design longitudinal studies, we sought to assess the in vivo reproducibility of this imaging technique. Methods: iMAP (40 MHz, Boston Scientific Corporation) was performed in patients referred for elective percutaneous intervention and in whom a nonintervened vessel was judged suitable for a safe IVUS analysis. Overall 20 patients with 20 non-angiographically significant lesions were assessed by two independent observers. Five of these 20 patients received an additional iMAP analysis using a new IVUS catheter and using the same catheter after its engagement and reengagement. Results: The interobserver relative difference in plaque area was 2.5%. Limits of agreement for lumen, vessel, and plaque area measurements were 1.62, -2.47 mm(2); 2.09, -3.71 mm(2); 2.80, -3.72 mm(2); respectively. Limits of agreement for fibrotic, lipidic, necrotic, and calcified measurements were 1.32, -1.44 mm(2); 0.24, -0.36 mm(2); 1.50, -2.26 mm(2); 0.09, -0.11 mm(2); respectively. The intercatheter and intracatheter relative difference in plaque area were 0.9% and 4.1%, respectively. Although the variability for compositional measurements increased using two different catheters or using the same catheter twice, the variability for compositional measurements keeps always below 10%. Conclusions: Our analysis demonstrates that the geometrical and compositional iMAP analysis is acceptably reproducible. (c) 2011 Wiley Periodicals, Inc

Researches of Automatic Steering Control Systems Using an Optical Flow Model

博士（工学）神戸大