Publications by authors named "Arie-Pieter Kappetein"
Background: The incidence and prognostic impact of major bleeding (MB) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown.
Objectives: The goal of this study was to investigate the rates and outcomes of MB after LMCAD revascularization.
Methods: In the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n = 957) and followed up for 5 years.
Objectives: Average treatment effects from randomized trials do not reflect the heterogeneity of an individual's response to treatment. This study evaluates the appropriate proportions of patients for coronary artery bypass grafting, or percutaneous intervention based on the predicted/observed ratio of 10-year all-cause mortality in the SYNTAX population.
Methods: The study included 1800 randomized patients and 1275 patients in the nested percutaneous (n = 198) or surgical (n = 1077) registries.
Background: Recently, machine learning algorithms have identified preprocedural γ-glutamyl transferase (GGT) as a significant predictor of long-term mortality after coronary revascularization in the SYNTAX (Synergy Between PCI [Percutaneous Coronary Intervention] With Taxus and Cardiac Surgery) trial. The aim of the present study is to investigate the impact of preprocedural GGT on 10-year all-cause mortality in patients with complex coronary artery disease after revascularization.
Methods And Results: The SYNTAX trial was a randomized trial comparing PCI with coronary artery bypass grafting in 1800 patients with complex coronary artery disease.
Article Synopsis
- - The study examined how complete revascularization after percutaneous coronary intervention (PCI) impacts patients with left main coronary artery disease, using data from the EXCEL trial involving 903 patients over a 5-year follow-up.
- - Findings showed that the risk of death or myocardial infarction (MI) did not significantly differ based on traditional measures of complete revascularization but was notably higher with a higher residual Jeopardy Score (rJS), particularly for patients with untreated severe stenoses in the left circumflex artery (LCX).
- - Specifically, patients with an rJS of 4 or more had worse outcomes, with increased mortality and spontaneous MI, highlighting the importance of addressing untreated high-grade lesions post-PCI for
Article Synopsis
- A study was conducted to examine hospital readmissions and their outcomes after revascularization procedures (PCI and CABG) for left main coronary artery disease (LMCAD) in the EXCEL trial, involving 1,905 patients.
- Results showed that within 5 years, nearly half of hospital survivors experienced readmissions, and the causes were split evenly between cardiovascular and noncardiovascular issues.
- Factors like PCI treatment, female sex, and preexisting health conditions were found to be significant predictors of readmission, which was linked to increased mortality risk, notably higher in patients who underwent PCI compared to CABG.
Research performed in Europe has driven cardiovascular device innovation. This includes, but is not limited to, percutaneous coronary intervention, cardiac imaging, transcatheter heart valve implantation, and device therapy of cardiac arrhythmias and heart failure. An important part of future medical progress involves the evolution of medical technology and the ongoing development of artificial intelligence and machine learning.
View Article and Find Full Text PDFImproving accuracy in diagnosing aortic stenosis severity: An in-depth analysis of echocardiographic measurement error through literature review and simulation study.
Echocardiography
September 2023
Article Synopsis
- - The study focuses on how measurement errors in echocardiograms can affect the diagnosis of severe aortic stenosis (AS), a condition where the aortic valve narrows, which can lead to unnecessary surgeries.
- - Out of 37 studies evaluated, nearly half acknowledged measurement errors, but none effectively addressed them, highlighting a significant gap in research practice.
- - Clinical simulations showed that these measurement errors could misclassify up to 42% of patients, emphasizing the need for more accurate assessments to guide treatment decisions and research outcomes.
In June 2021, HVAD System distribution ceased due to observational data demonstrating increased mortality and neurological events compared to another commercial device, and a device malfunction with delay or failure to restart, especially in certain subpopulations. To assess ongoing risk for patients on support following subsequent device recalls, the manufacturer's Intermacs HVAD System 2022 Quarterly Reports were queried to identify mortality and adverse events trends in a contemporary cohort of 3110 primary HVAD implantations since October 2017, stratified by year-of-implant. Mean duration of support was 21 ± 16 months, with 33% alive on original device, 25% transplanted, 6% undergoing device exchange, 4% recovered, and 32% expired.
View Article and Find Full Text PDFThe SYNTAX trial randomized patients equally eligible for coronary artery bypass grafting or percutaneous coronary intervention using the Heart Team approach. The SYNTAXES study achieved a follow-up rate of 93.8% and reported the 10-year vital status.
View Article and Find Full Text PDFArticle Synopsis
- The SYNTAXES study examined the long-term effects of repeat revascularization (RR) on 10-year mortality in patients with three-vessel and/or left main coronary artery disease after PCI or CABG, following previous findings from the SYNTAX trial.
- A total of 330 patients (18.3%) underwent RR within 5 years, with those who had PCI initially showing a higher 10-year mortality risk compared to those who had CABG.
- Overall, RR within 5 years did not significantly impact 10-year mortality rates, indicating a need for further research in larger populations to clarify these results.
Article Synopsis
- * Non-fatal PMAE were found to be less common after PCI compared to CABG, but they significantly predicted mortality within the first year despite not impacting long-term outcomes.
- * Optimal medical therapy (OMT) may improve survival in patients experiencing non-fatal PMAE, particularly in the first year post-procedure, emphasizing the need for closer follow-up during this time.
Impact of residual angina on long-term clinical outcomes after percutaneous coronary intervention or coronary artery bypass graft for complex coronary artery disease.
Eur Heart J Qual Care Clin Outcomes
August 2023
Aims: The aim of this study was to investigate the impact on 10-year survival of patient-reported anginal status at 1 year following percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD) and/or three-vessel CAD (3VD).
Methods And Results: In this post hoc analysis of the randomized SYNTAX Extended Survival study, patients were classified as having residual angina (RA) if their self-reported Seattle Angina Questionnaire angina frequency (SAQ-AF) scale was ≤90 at the 1-year follow-up post-revascularization with PCI or CABG. The primary endpoint of all-cause death at 10 years was compared between the RA and no-RA groups.
Article Synopsis
- The study focuses on how preprocedural physical and mental health impacts outcomes for patients with complex coronary artery disease undergoing either PCI or CABG, using data from the SYNTAXES trial.* -
- Higher scores in physical and mental health were linked to lower 10-year mortality rates; specifically, a 10-point increase in these scores reduced the risk of death significantly.* -
- Among patients with good health scores, CABG offered a better survival rate than PCI, while no significant differences in mortality were found for those with lower health scores.*
Objective: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).
Methods: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.
Background: We investigated outcomes of coronary artery bypass grafting (CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH) within the Evaluation of XIENCE Versus CABG (EXCEL) trial.
Methods: All patients in EXCEL randomized to CABG were included in this study. For this analysis, the primary end points were ischemia-driven revascularization (IDR) and graft stenosis or occlusion at 5 years.
Objectives: The aim of this study was to assess 10-year all-cause mortality in patients with heavily calcified lesions (HCLs) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
Background: Limited data are available on very long term outcomes in patients with HCLs according to the mode of revascularization.
Methods: This substudy of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study assessed 10-year all-cause mortality according to the presence of HCLs within lesions with >50% diameter stenosis and identified during the calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score among 1,800 patients with the 3-vessel disease and/or left main disease randomized to PCI or CABG in the SYNTAX trial.
Background: Creatinine clearance (CrCl) is an independent determinant of mortality in predictive models of revascularisation outcomes for complex coronary artery disease.
Aims: This study aimed to investigate the impact of preprocedural biological markers on 10-year mortality following coronary revascularisation.
Methods: The SYNTAX Extended Survival (SYNTAXES) study evaluated the 10-year vital status follow-up of 1,800 patients with de novo three-vessel (3VD) and/or left main coronary artery disease (LMCAD) randomised to include percutaneous or surgical coronary revascularisation.
Article Synopsis
- The study aimed to evaluate how existing cardiovascular disease (CVD) affects the risk of death over 10 years after coronary revascularization in patients with complex coronary artery disease (CAD).
- It found that patients with established CVD had a significantly higher risk of 10-year all-cause death compared to those without CVD, and the risk was especially elevated for those with CVD affecting multiple heart territories.
- The results suggest that while patients with CVD may face some increased risks, they should not be automatically excluded from undergoing necessary treatments like angiography or revascularization, as the long-term outcomes remain acceptable.
Article Synopsis
- The study aimed to compare long-term all-cause mortality between patients undergoing percutaneous coronary intervention (PCI) and those receiving coronary artery bypass grafting (CABG) with either multiple arterial grafting (MAG) or single arterial grafting (SAG).
- A total of 1,743 patients were followed for an average of 11.9 years, revealing that all-cause mortality was significantly lower in the MAG group compared to PCI, while SAG did not show a significant difference.
- The results indicate that for patients with three-vessel disease (3VD), both MAG and SAG offered better survival rates than PCI, whereas for those with left main coronary artery disease (LMCAD), there were no significant differences in mortality
Article Synopsis
- The article investigates the 10-year all-cause death rates in patients with three-vessel disease (3VD) or left main coronary artery disease (LMCAD) who underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI), focusing on the impact of diabetes.
- In diabetics, initial results indicated a higher mortality rate with PCI compared to CABG at 5 years, but by 10 years, the rates were similar for both procedures regardless of diabetic status, with a slight advantage seen for CABG in insulin-treated patients.
- The study concludes that while CABG may offer some survival benefits for patients with insulin-dependent diabetes, further research is needed to understand the long-term outcomes associated
Background: The significant interaction between major infection and 5-year mortality after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) for complex coronary artery disease (CAD) was observed previously. However, the very long-term outcomes beyond 5 years remains unclear.
Methods And Results: This is a subgroup analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the randomized SYNTAX trial comparing PCI versus CABG in patients with three-vessel disease (3VD) or left-main CAD (LMCAD).
Background: The EXCEL trial reported similar five-year rates of the primary composite outcome of death, myocardial infarction (MI), or stroke after percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) for treatment of obstructive left main coronary artery disease (LMCAD).
Aims: We sought to determine whether these outcomes remained consistent regardless of geography of enrolment.
Methods: We performed a prespecified subgroup analysis based on regional enrolment.
Background: The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial.
Objectives: The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG.
Methods: This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial.
Objectives: To assess the safety and efficacy of using vascular closure devices (VCDs) in percutaneous coronary intervention (PCI) for left main coronary artery disease (LM-CAD).
Background: VCDs provide rapid hemostasis for patients undergoing PCI with transfemoral access (TFA); however, the safety and efficacy of VCDs continues to be debated.
Methods: We analyzed data from the EXCEL trial in patients with LM-CAD in whom PCI was performed via TFA with vs without VCD.