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  • 1.
    Andell, Pontus
    et al.
    Lund Univ, Sweden.
    Berntorp, Karolina
    Lund Univ, Sweden.
    Christiansen, Evald H.
    Aarhus Univ Hosp, Denmark.
    Gudmundsdottir, Ingibjorg J.
    Univ Hosp Iceland, Iceland.
    Sandhall, Lennart
    Helsingborg Hosp, Sweden.
    Venetsanos, Dimitrios
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Erlinge, David
    Lund Univ, Sweden.
    Frobert, Ole
    Orebro Univ, Sweden.
    Koul, Sasha
    Lund Univ, Sweden.
    Reitan, Christian
    Lund Univ, Sweden.
    Gotberg, Matthias
    Lund Univ, Sweden.
    Reclassification of Treatment Strategy With Instantaneous Wave-Free Ratio and Fractional Flow Reserve A Substudy From the iFR-SWEDEHEART Trial2018In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 11, no 20, p. 2084-2094Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES The authors sought to compare reclassification of treatment strategy following instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR). BACKGROUND iFR was noninferior to FFR in 2 large randomized controlled trials in guiding coronary revascularization. Reclassification of treatment strategy by FFR is well-studied, but similar reports on iFR are lacking. METHODS The iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome Trial) study randomized 2,037 participants with stable angina or acute coronary syndrome to treatment guided by iFR or FFR. Interventionalists entered the preferred treatment (optimal medical therapy [OMT], percutaneous coronary intervention [PCI], or coronary artery bypass grafting [CABG]) on the basis of coronary angiograms, and the final treatment decision was mandated by the iFR/FFR measurements. RESULTS In the iFR/FFR (n = 1,009/n = 1,004) populations, angiogram-based treatment approaches were similar (p = 0.50) with respect to OMT (38%/35%), PCI of 1 (37%/39%), 2 (15%/16%), and 3 vessels (2%/2%) and CABG (8%/8%). iFR and FFR reclassified 40% and 41% of patients, respectively (p = 0.78). The majority of reclassifications were conversion of PCI to OMT in both the iFR/FFR groups (31.4%/29.0%). Reclassification increased with increasing number of lesions evaluated (odds ratio per evaluated lesion for FFR: 1.46 [95% confidence interval: 1.22 to 1.76] vs. iFR 1.37 [95% confidence interval: 1.18 to 1.59]). Reclassification rates for patients with 1, 2, and 3 assessed vessels were 36%, 52%, and 53% (p amp;lt; 0.01). CONCLUSIONS Reclassification of treatment strategy of intermediate lesions was common and occurred in 40% of patients with iFR or FFR. The most frequent reclassification was conversion from PCI to OMT regardless of physiology modality. Irrespective of the physiological index reclassification of angiogram-based treatment strategy increased with the number of lesions evaluated. (c) 2018 by the American College of Cardiology Foundation.

  • 2.
    Escaned, Javier
    et al.
    Hosp Clin San Carlos, Spain; Univ Complutense Madrid, Spain.
    Ryan, Nicola
    Hosp Clin San Carlos, Spain; Univ Complutense Madrid, Spain.
    Mejia-Renteria, Hernan
    Hosp Clin San Carlos, Spain; Univ Complutense Madrid, Spain.
    Cook, Christopher M.
    Imperial Coll London, England.
    Dehbi, Hakim-Moulay
    UCL, England.
    Alegria-Barrero, Eduardo
    Hosp Univ Torrejon, Spain; Univ Francisco de Vitoria, Spain.
    Alghamdi, Ali
    King Abdulaziz Med City Cardiac Ctr, Saudi Arabia.
    Al-Lamee, Rasha
    Imperial Coll London, England.
    Altman, John
    Colorado Heart and Vasc, CO USA.
    Ambrosia, Alphonse
    Mesa, Arizona, USA.
    Baptista, Sergio B.
    Hosp Prof Doutor Fernando Fonseca, Portugal.
    Bertilsson, Maria
    Uppsala Univ, Sweden.
    Bhindi, Ravinay
    Royal North Shore Hosp, Australia.
    Birgander, Mats
    Lund Univ, Sweden.
    Bojara, Waldemar
    Kemperhof Koblenz, Germany.
    Brugaletta, Salvatore
    Inst Invest Biomed August Pi and Sunyer, Spain.
    Buller, Christopher
    St Michaels Hosp, Canada.
    Calais, Fredrik
    Orebro Univ, Sweden.
    Silva, Pedro Canas
    Hosp Santa Maria, Portugal.
    Carlsson, Jorg
    Kalmar Cty Hosp, Sweden; Linnaeus Univ, Sweden.
    Christiansen, Evald H.
    Aarhus Univ Hosp, Denmark.
    Danielewicz, Mikael
    Karlstad Hosp, Sweden.
    Di Mario, Carlo
    Imperial Coll London, England; Univ Florence, Italy.
    Doh, Joon-Hyung
    Inje Univ, South Korea.
    Erglis, Andrejs
    Pauls Stradins Clin Univ Hosp, Latvia.
    Erlinge, David
    Lund Univ, Sweden.
    Gerber, Robert T.
    Conquest Hosp, England.
    Going, Olaf
    Sana Klinikum Lichtenberg, Germany.
    Gudmundsdottir, Ingibjorg
    Reykjavik Univ Hosp, Iceland.
    Haerle, Tobias
    Carl von Ossietzky Univ Oldenburg, Germany.
    Hauer, Dario
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Hellig, Farrel
    Sunninghill Hosp, South Africa.
    Indolfi, Ciro
    Magna Graecia Univ Catanzaro, Italy.
    Jakobsen, Lars
    Aarhus Univ Hosp, Denmark.
    Janssens, Luc
    Imelda Hosp, Belgium.
    Jensen, Jens
    Karolinska Inst, Sweden; Capio St Gorans Sjukhus, Sweden; Sundsvall Hosp, Sweden.
    Jeremias, Allen
    SUNY Stony Brook, NY 11794 USA.
    Karegren, Amra
    Vastmanland Hosp Vasteras, Sweden.
    Karlsson, Ann-Charlotte
    Halmstad Cty Hosp, Sweden.
    Kharbanda, Rajesh K.
    Oxford Univ Hosp Fdn Trust, England.
    Khashaba, Ahmed
    Ain Shams Univ, Egypt.
    Kikuta, Yuetsu
    Fukuyama Cardiovasc Hosp, Japan.
    Krackhardt, Florian
    Univ Med, Germany.
    Koo, Bon-Kwon
    Seoul Natl Univ Hosp, South Korea.
    Koul, Sasha
    Lund Univ, Sweden.
    Laine, Mika
    Helsinki Univ Hosp, Finland.
    Lehman, Sam J.
    Flinders Univ S Australia, Australia.
    Lindroos, Pontus
    St Goran Hosp, Sweden.
    Malik, Iqbal S.
    Imperial Coll London, England.
    Maeng, Michael
    Aarhus Univ Hosp, Denmark.
    Matsuo, Hitoshi
    Gifu Heart Ctr, Japan.
    Meuwissen, Martijn
    Amphia Hosp, Netherlands.
    Nam, Chang-Wook
    Keimyung Univ, South Korea.
    Niccoli, Giampaolo
    Univ Cattolica Sacro Cuore, Italy.
    Nijjer, Sukhjinder S.
    Imperial Coll London, England.
    Olsson, Hans
    Karlstad Hosp, Sweden.
    Olsson, Sven-Erik
    Helsingborg Hosp, Sweden; Helsingborg Hosp, Sweden.
    Omerovic, Elmir
    Sahlgrenska Univ Gothenburg, Sweden.
    Panayi, Georgios
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Petraco, Ricardo
    Imperial Coll London, England.
    Piek, Jan J.
    Acad Med Ctr, Netherlands.
    Ribichini, Flavo
    Univ Hosp Verona, Italy.
    Samady, Habib
    Emory Univ, GA 30322 USA.
    Samuels, Bruce
    Cedars Sinai Heart Inst, CA USA.
    Sandhall, Lennart
    Helsingborg Hosp, Sweden; Helsingborg Hosp, Sweden.
    Sapontis, James
    MonashHeart, Australia; Monash Univ, Australia.
    Sen, Sayan
    Imperial Coll London, England.
    Seto, Arnold H.
    Vet Affairs Long Beach Healthcare Syst, CA USA.
    Sezer, Murat
    Istanbul Univ, Turkey.
    Sharp, Andrew S. P.
    Royal Devon and Exeter Hosp, England; Univ Exeter, England.
    Shin, Eun-Seok
    Univ Ulsan, South Korea.
    Singh, Jasvindar
    Washington Univ, MO USA.
    Takashima, Hiroaki
    Aichi Med Univ Hosp, Japan.
    Talwar, Suneel
    Royal Bournemouth Gen Hosp, England.
    Tanaka, Nobuhiro
    Tokyo Med Univ, Japan.
    Tang, Kare
    Essex Cardiothorac Ctr, England; Anglia Ruskin Univ, England.
    Van Belle, Eric
    Lille Univ Hosp, France; INSERM, France.
    van Royen, Niels
    Vrije Univ Amsterdam Med Ctr, Netherlands.
    Varenhorst, Christoph
    Uppsala Univ, Sweden.
    Vinhas, Hugo
    Hosp Garcia de Horta, Portugal.
    Vrints, Christiaan J.
    Antwerp Univ Hosp, Belgium.
    Walters, Darren
    Prince Charles Hosp, Australia.
    Yokoi, Hiroyoshi
    Fukuoka Sannou Hosp, Japan.
    Frobert, Ole
    Orebro Univ, Sweden.
    Patel, Manesh R.
    Duke Univ, NC USA.
    Serruys, Patrick
    Imperial Coll London, England.
    Davies, Justin E.
    Imperial Coll London, England.
    Gotberg, Matthias
    Lund Univ, Sweden.
    Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes2018In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 11, no 15, p. 1437-1449Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p amp;lt; 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

  • 3.
    Montalescot, Gilles
    et al.
    University of Paris 06, France.
    vant Hof, Arnoud W.
    Isala Clin, Netherlands.
    Bolognese, Leonardo
    Azienda Osped Arezzo, Italy.
    Cantor, Warren J.
    University of Toronto, Canada.
    Cequier, Angel
    University of Barcelona, Spain.
    Chettibi, Mohamed
    Centre Hospital University of Frantz Fanon, Algeria.
    Collet, Jean-Philippe
    University of Paris 06, France.
    Goodman, Shaun G.
    University of Toronto, Canada.
    Hammett, Christopher J.
    Royal Brisbane and Womens Hospital, Australia.
    Huber, Kurt
    Wilhelminenhosp, Austria.
    Janzon, Magnus
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Lapostolle, Frederic
    SAMU 93 Hop Avicenne, France.
    Flensted Lassen, Jens
    Aarhus University Hospital, Denmark.
    Licour, Muriel
    AstraZeneca, France.
    Merkely, Bela
    Semmelweis University, Hungary.
    Salhi, Nejoua
    AstraZeneca, England.
    Silvain, Johanne
    University of Paris 06, France.
    Storey, Robert F.
    University of Sheffield, England.
    ten Berg, Jurrien M.
    St Antonius Hospital, Netherlands.
    Tsatsaris, Anne
    AstraZeneca, France.
    Zeymer, Uwe
    Klinikum Ludwigshafen, Germany; Institute Herzinfarktforsch Ludwigshafen, Germany.
    Vicaut, Eric
    University of Paris 07, France.
    Hamm, Christian W.
    Kerckhoff Heart Centre, Germany.
    Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction The ATLANTIC-H-24 Analysis2016In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 9, no 7, p. 646-656Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES The aim of this landmark exploratory analysis, ATLANTIC-H-24, was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. BACKGROUND The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). METHODS The ATLANTIC-H-24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, >= 70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. RESULTS Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. CONCLUSIONS The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580]) (C) 2016 by the American College of Cardiology Foundation.

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