Publications by authors named "Gregg W Stone"
Background: The relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography.
Methods: Clinically indicated stress testing included nuclear imaging, echocardiography, cardiac magnetic resonance imaging, or nonimaging exercise tolerance test.
Article Synopsis
- Coronary intravascular lithotripsy (IVL) is an effective method for stent implantation in severely calcified lesions, specifically those with calcified nodules (CNs).
- In a study of 155 patients, IVL demonstrated similar outcomes in terms of stent area and expansion, regardless of the presence of CNs, even though CNs had higher calcium volume and angle.
- The 2-year rate of target lesion failure was not significantly different between CN and non-CN lesions, suggesting that further research is needed to evaluate different treatment methods for these types of lesions.
Current evidence indicates that dual antiplatelet therapy with aspirin plus a P2Y inhibitor is essential for the prevention of thrombotic events after percutaneous coronary interventions. However, dual antiplatelet therapy is associated with increased bleeding which may outweigh the benefits. This has set the foundations for customizing antiplatelet treatments to the individual patient.
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- The BIONICS and NIREUS trials compared the ridaforolimus-eluting stent (RES) and zotarolimus-eluting stent (ZES), showing that RES was noninferior to ZES for 1-year target-lesion failure and 6-month lumen loss.
- A pooled analysis of 2221 patients over 5 years found similar rates of target-lesion failure (12.2% for RES vs 11.3% for ZES), with no significant differences in other outcomes like myocardial infarction or stent thrombosis.
- Although the RES group had higher rates of target-vessel revascularization and cardiac death, these differences were not significant after adjusting for patient characteristics, indicating long-term
Background: Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) reduces the risk for clinical events in patients with acute coronary syndromes (ACS), compared with angiographic guidance. However, the benefits of IVUS guidance in high-risk patients with diabetes with ACS is uncertain.
Objectives: The aim of this prespecified stratified subgroup analysis from the IVUS-ACS randomized trial was to determine the effectiveness of IVUS-guided PCI vs angiography-guided PCI in patients with diabetes with ACS.
Background: Whether revascularisation (REV) improves outcomes in patients with three-vessel coronary artery disease (3V-CAD) is uncertain.
Aims: Our objective was to evaluate outcomes with REV (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) versus medical therapy in patients with 3V-CAD.
Methods: ISCHEMIA participants with 3V-CAD on coronary computed tomography angiography without prior CABG were included.
Article Synopsis
- - The article discusses the growing popularity of the win ratio method in cardiovascular trials, highlighting its advantages over conventional composite outcomes and its various applications for analyzing clinical data.
- - Key topics covered include the workings and interpretation of the win ratio, guidelines for selecting clinical outcomes, and additional measures like the win difference to assess absolute benefits in studies.
- - It emphasizes the need for correct application, discusses potential misuses, and provides recommendations for future research, complemented by examples from cardiology trials and included statistical methods.
Article Synopsis
- In a study analyzing patients during high-risk percutaneous coronary intervention (HR-PCI), nearly half (49%) experienced loss of pulse pressure (LOPP), defined as a mean pulse pressure below 20 mm Hg for 5 seconds or more.
- Patients with LOPP demonstrated significantly lower baseline systolic and mean arterial blood pressures and a higher heart rate compared to those without LOPP.
- The occurrence of LOPP was linked to a higher incidence of serious complications including major adverse cardiac events, acute kidney injury, and death within 90 days, with low systolic blood pressure and cardiomyopathy identified as strong predictors of LOPP.
Article Synopsis
- - The BRIGHT-4 study showed that using bivalirudin with a high-dose infusion after PCI led to lower overall mortality and bleeding risks compared to heparin, without raising rates of reinfarction or stent thrombosis in STEMI patients.
- - A meta-analysis of six trials involving over 15,000 patients found that while bivalirudin reduced overall and cardiac mortality and major bleeding, it was associated with higher rates of reinfarction and stent thrombosis compared to heparin.
- - When specifically looking at a subset of trials similar to the BRIGHT-4 approach, bivalirudin also showed a decrease in 30-day mortality and major bleeding, with comparable rates of reinfar
Article Synopsis
- There’s a debate about how long patients with heart problems should take two types of medicine together, called dual antiplatelet therapy (DAPT).
- Researchers wanted to see how effective and safe different lengths of DAPT are for patients who have serious heart issues and receive a special procedure to help their hearts.
- They found that taking DAPT for just 1 month followed by another medicine might reduce serious bleeding, but didn't change the number of heart problems compared to taking DAPT for 12 months.
Article Synopsis
- The study looked at two medicines, bivalirudin and heparin, to see which one is safer and better for patients with a serious heart problem called STEMI who are getting a treatment called PCI.
- Many patients didn't use a certain type of medicine (GPI) during the treatment, and those on bivalirudin had better results with fewer deaths and less bleeding.
- However, for those who needed the GPI medicine, there weren't big differences in the results between the two treatments.
Article Synopsis
- Lipid content in nonobstructive coronary lesions can lead to poor clinical outcomes, particularly in relation to complications after stenting during percutaneous coronary intervention (PCI).
- A study using near-infrared spectroscopy and intravascular ultrasound evaluated the relationship between lipid levels and major adverse cardiac events (MACE) in patients who underwent PCI for myocardial infarction.
- Findings showed that high lipid levels and plaque burden at stent edges increased the risk of stent edge-related MACE, while pre- and post-PCI lipid content did not correlate with in-stent MACE.
Article Synopsis
- An interatrial shunt is being studied as a potential treatment for heart failure, aimed at lowering left atrial pressure and improving symptoms and outcomes for patients.
- In a clinical trial involving 508 patients, participants were randomly assigned to receive either the shunt or a placebo, with their progress tracked over a maximum of two years.
- Results showed that while the shunt had no major safety issues, it did not significantly improve overall effectiveness compared to the placebo, although it appeared to reduce adverse cardiovascular events in patients with reduced left ventricular ejection fraction.
Background: The implications of pulmonary vein (PV) flow patterns in patients with heart failure (HF) and mitral regurgitation (MR) are uncertain. We examined PV flow patterns in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial (NCT01626079), in which patients with HF and moderate-to-severe or severe functional MR were randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip device plus guideline-directed medical therapy (GDMT) vs. GDMT alone.
View Article and Find Full Text PDFIntravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI.
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- The review highlights a lack of evidence in coronary revascularization decisions specifically for women and minorities and introduces the RECHARGE trial program aimed at addressing this gap.
- The RECHARGE program includes two trials: one focused on women and the other on Black or Hispanic patients, comparing CABG and PCI treatments over a follow-up period of up to 10 years.
- Key outcomes will assess quality of life and mortality, with a focus on patient-centered measures, making these trials unique in their approach to these underrepresented populations.
Article Synopsis
- The study analyzed data from 7 trials with 1,774 STEMI patients to understand how the location of the infarct artery affects heart injury and outcomes after primary coronary intervention.
- Results showed that patients with anterior STEMI (affecting the left anterior descending artery) had a larger median infarct size and were at a higher risk for mortality and heart failure hospitalization compared to those with nonanterior STEMI.
- The research concluded that anterior STEMI leads to more severe heart damage and worse overall prognosis, highlighting the importance of infarct location in patient outcomes.
Article Synopsis
- In randomized trials, deaths that are unrelated to the primary outcome being studied are classified as competing risks, and traditional analysis methods may inaccurately treat these deaths like censored data.
- The Fine and Gray model, often used for analyzing competing risks, can be misapplied and potentially deliver misleading results.
- The authors suggest a new multiple imputation approach that better accounts for the risk factors associated with both death and the outcomes of interest, and they provide recommendations for future trials based on their findings from three cardiovascular studies.
Background: Dual antiplatelet therapy (DAPT) for 12 months is the standard of care after coronary stenting in patients with acute coronary syndrome (ACS). The aim of this individual patient-level meta-analysis was to summarise the evidence comparing DAPT de-escalation to ticagrelor monotherapy versus continuing DAPT for 12 months after coronary drug-eluting stent implantation.
Methods: A systematic review and individual patient data (IPD)-level meta-analysis of randomised trials with centrally adjudicated endpoints was performed to evaluate the comparative efficacy and safety of ticagrelor monotherapy (90 mg twice a day) after short-term DAPT (from 2 weeks to 3 months) versus 12-month DAPT in patients undergoing percutaneous coronary intervention with a coronary drug-eluting stent.
Background And Aims: Observational registries have suggested that optical coherence tomography (OCT) imaging-derived parameters may predict adverse events after drug-eluting stent (DES) implantation. The present analysis sought to determine the OCT predictors of clinical outcomes from the large-scale ILUMIEN IV trial.
Methods: ILUMIEN IV was a prospective, single-blind trial of 2487 patients with diabetes or high-risk lesions randomized to OCT-guided versus angiography-guided DES implantation.
Background: Considering the high prevalence of mitral regurgitation (MR) and the highly subjective, variable MR severity reporting, an automated tool that could screen patients for clinically significant MR (≥ moderate) would streamline the diagnostic/therapeutic pathways and ultimately improve patient outcomes.
Objectives: The authors aimed to develop and validate a fully automated machine learning (ML)-based echocardiography workflow for grading MR severity.
Methods: ML algorithms were trained on echocardiograms from 2 observational cohorts and validated in patients from 2 additional independent studies.