Antithrombotic therapy in patients undergoing TAVI: An overview of Dutch hospitals

Purpose To assess current antithrombotic treatment strategies in the Netherlands in patients undergoing transcatheter aortic valve implantation (TAVI). Methods For every Dutch hospital performing TAVI (n =14) an interventional cardiologist experienced in performing TAVI was interviewed concerning heparin, aspirin, thienopyridine and oral anticoagulation treatment in patients undergoing TAVI. Results The response rate was 100 %. In every centre, a protocol for antithrombotic treatment after TAVI was available. Aspirin was prescribed in all centres, concomitant clopidogrel was prescribed 13 of the 14 centres. Duration of concomitant clopidogrel was 3 months in over twothirds of cases. In 2 centres, duration of concomitant clopidogrel was based upon type of prosthesis: 6 months versus 3 months for supra-annular and intra-annular prostheses, respectively. Conclusions Leaning on a small basis of evidence and recommendations, the antithrombotic policy for patients undergoing TAVI is highly variable in the Netherlands. As a standardised regimen might further reduce haemorrhagic complications, large randomised clinical trials may help to establish the most appropriate approach

Recommendations for the use of bioresorbable vascular scaffolds in percutaneous coronary interventions

Background To eliminate some of the potential late limitations of permanent metallic stents, the bioresorbable coronary stents or ‘bioresorbable vascular scaffolds’ (BVS) have been developed. Methods We reviewed all currently available clinical data on BVS implantation. Results Since the 2015 position statement on the appropriateness of BVS in percutaneous coronary interventions, several large randomised trials have been presented. These have demonstrated that achieving adequate 1 and 2 year outcomes with these first-generation BVS is not straightforward. These first adequately powered studies in non-complex lesions showed worse results if standard implan- tation techniques were used for these relatively thick scaffolds. Post-hoc analyses hypothesise that outcomes similar to current drug-eluting stents are still possible if aggressive lesion preparation, adequate sizing and high-pressure postdilatation are implemented rigorously. As long as this has not been confirmed in prospective studies the usage should be restricted to experienced centres with continuous outcome monitoring. For more complex lesions, results are even more disappointing and usage should be discouraged. When developed, newer generation scaffolds with thinner struts or faster resorption rates are expected to improve outcomes. In the meantime prolonged dual antiplatelet therapy (DAPT, beyond one year) is recommended in an individu-alised approach for patients treated with current generation BVS. Conclusion The new 2017 recommendations downgrade and limit the use of the current BVS to experienced centres within dedicated registries using the updated implantation protocol and advise the prolonged usage of DAPT. In line with these recommendations the manufacturer does not supply devices to the hospitals without such registries in place

Rationale and design of the EXAMINATION trial: A randomised comparison between everolimus-eluting stents and cobalt-chromium bare-metal stents in ST-elevation myocardial infarction

Aims: To assess the performance of the everolimus-eluting stent (EES) versus cobalt chromium bare-metal stent (BMS) in the setting of primary percutaneous coronary intervention for treatment of patients presenting with ST-segment elevation myocardial infarction (STEMI). The implantation of a drug-eluting stent in the setting of an acute myocardial infarction is still controversial. In several registries this clinical scenario has been associated with the development of stent thrombosis. The EES has demonstrated to reduce the stent thrombosis rate as compared to paclitaxel-eluting stent in randomised controlled trials, mainly performed in patients in stable clinical conditions. There are however few data regarding the effectiveness of EES in the context of STEMI. Methods and results: This is an investigator-driven, prospective, multicentre, multinational, randomised, single blind, two-arm, controlled trial (ClinicalTrials.gov number: NCT00828087). This trial, with an all comer design, randomises approximately 1,500 patients 1:1 to EES or BMS. Overall, any patient presenting with STEMI up to 48 hours who requires emergent percutaneous coronary intervention can be included. The primary endpoint is the patient-oriented combined endpoint of all-cause death, any myocardial infarction and any revascularisation at 1-year according to the Academic Research Consortium. Clinical follow-up will be scheduled at 30 days, six months, one year and yearly up to five years. No angiographic follow-up is mandated per protocol. Conclusions: This trial with broad inclusion and few exclusion criteria will shed light on the performance of the second generation EES in the complex scenario of STEMI

Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

BACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in greater relief from angina and improved quality of life. The effect of PCI with the use of drug-eluting stents on these outcomes is unknown. METHODS: In a large, randomized trial, we assigned 1800 patients with three-vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxeleluting stents (903 patients). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary end point was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status). RESULTS: The scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months (P = 0.04 and P = 0.03, respectively), but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 month and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs. 71.6%, P = 0.05). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period. CONCLUSIONS: Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small. (Funded by Boston Scientific; ClinicalTrials.gov number, NCT00114972.). Copyrigh

Measurements of hydrodynamics, sediment, morphology and benthos on Ameland ebb-tidal delta and lower shoreface

A large-scale field campaign was carried out on the ebb-tidal delta (ETD) of Ameland Inlet, a basin of the Wadden Sea in the Netherlands, as well as on three transects along the Dutch lower shoreface. The data have been obtained over the years 2017-2018. The most intensive campaign at the ETD of Ameland Inlet was in September 2017. With this campaign, as part of KustGenese2.0 (Coastal Genesis 2.0) and SEAWAD, we aim to gain new knowledge on the processes driving sediment transport and benthic species distribution in such a dynamic environment. These new insights will ultimately help the development of optimal strategies to nourish the Dutch coastal zone in order to prevent coastal erosion and keep up with sea level rise. The dataset obtained from the field campaign consists of (i) single-and multi-beam bathymetry; (ii) pressure, water velocity, wave statistics, turbidity, conductivity, temperature, and bedform morphology on the shoal; (iii) pressure and velocity at six back-barrier locations; (iv) bed composition and macrobenthic species from box cores and vibrocores; (v) discharge measurements through the inlet; (vi) depth and velocity from X-band radar; and (vii) meteorological data. The combination of all these measurements at the same time makes this dataset unique and enables us to investigate the interactions between sediment transport, hydrodynamics, morphology and the benthic ecosystem in more detail. The data provide opportunities to calibrate numerical models to a high level of detail. Furthermore, the open-source datasets can be used for system comparison studies. The data are publicly available at 4TU Centre for Research Data at https://doi.org/10.4121/collection:seawad (Delft University of Technology et al., 2019) and https://doi.org/10.4121/collection:kustgenese2 (Rijkswaterstaat and Deltares, 2019). The datasets are published in netCDF format and follow conventions for CF (Climate and Forecast) metadata. The http://data.4tu.nl (last access: 11 November 2020) site provides keyword searching options and maps with the geographical position of the data

Measurements of hydrodynamics, sediment, morphology and benthos on Ameland ebb-tidal delta and lower shoreface

A large-scale field campaign was carried out on the ebb-tidal delta (ETD) of Ameland Inlet, a basin of the Wadden Sea in the Netherlands, as well as on three transects along the Dutch lower shoreface. The data have been obtained over the years 2017-2018. The most intensive campaign at the ETD of Ameland Inlet was in September 2017. With this campaign, as part of KustGenese2.0 (Coastal Genesis 2.0) and SEAWAD, we aim to gain new knowledge on the processes driving sediment transport and benthic species distribution in such a dynamic environment. These new insights will ultimately help the development of optimal strategies to nourish the Dutch coastal zone in order to prevent coastal erosion and keep up with sea level rise. The dataset obtained from the field campaign consists of (i) single-and multi-beam bathymetry; (ii) pressure, water velocity, wave statistics, turbidity, conductivity, temperature, and bedform morphology on the shoal; (iii) pressure and velocity at six back-barrier locations; (iv) bed composition and macrobenthic species from box cores and vibrocores; (v) discharge measurements through the inlet; (vi) depth and velocity from X-band radar; and (vii) meteorological data. The combination of all these measurements at the same time makes this dataset unique and enables us to investigate the interactions between sediment transport, hydrodynamics, morphology and the benthic ecosystem in more detail. The data provide opportunities to calibrate numerical models to a high level of detail. Furthermore, the open-source datasets can be used for system comparison studies. The data are publicly available at 4TU Centre for Research Data at https://doi.org/10.4121/collection:seawad (Delft University of Technology et al., 2019) and https://doi.org/10.4121/collection:kustgenese2 (Rijkswaterstaat and Deltares, 2019). The datasets are published in netCDF format and follow conventions for CF (Climate and Forecast) metadata. The http://data.4tu.nl (last access: 11 November 2020) site provides keyword searching options and maps with the geographical position of the data