Publications by authors named "Eduardo Alegria-Barrero"

55 Publications

Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic.

Cardiovasc Diabetol 2021 03 23;20(1):69. Epub 2021 Mar 23.

pInvestiga, Moaña, Pontevedra, Spain.

Background: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes.

Objectives: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome.

Methods: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared.

Results: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables.

Conclusion: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.
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http://dx.doi.org/10.1186/s12933-021-01261-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986134PMC
March 2021

Consequences of canceling elective invasive cardiac procedures during Covid-19 outbreak.

Catheter Cardiovasc Interv 2020 Dec 17. Epub 2020 Dec 17.

pInvestiga, Pontevedra, Spain.

Background: During COVID-19 pandemic in Spain, elective procedures were canceled or postponed, mainly due to health care systems overwhelming.

Objective: The objective of this study was to evaluate the consequences of interrupting invasive procedures in patients with chronic cardiac diseases due to the COVID-19 outbreak in Spain.

Methods: The study population is comprised of 2,158 patients that were pending on elective cardiac invasive procedures in 37 hospitals in Spain on the 14th of March 2020, when a state of alarm and subsequent lockdown was declared in Spain due to the COVID-19 pandemic. These patients were followed-up until April 31th.

Results: Out of the 2,158 patients, 36 (1.7%) died. Mortality was significantly higher in patients pending on structural procedures (4.5% vs. 0.8%, respectively; p < .001), in those >80 year-old (5.1% vs. 0.7%, p < .001), and in presence of diabetes (2.7% vs. 0.9%, p = .001), hypertension (2.0% vs. 0.6%, p = .014), hypercholesterolemia (2.0% vs. 0.9%, p = .026) [Correction added on December 23, 2020, after first online publication: as per Dr. Moreno's request changes in p-values were made after original publication in Abstract.], chronic renal failure (6.0% vs. 1.2%, p < .001), NYHA > II (3.8% vs. 1.2%, p = .001), and CCS > II (4.2% vs. 1.4%, p = .013), whereas was it was significantly lower in smokers (0.5% vs. 1.9%, p = .013). Multivariable analysis identified age > 80, diabetes, renal failure and CCS > II as independent predictors for mortality.

Conclusion: Mortality at 45 days during COVID-19 outbreak in patients with chronic cardiovascular diseases included in a waiting list due to cancellation of invasive elective procedures was 1.7%. Some clinical characteristics may be of help in patient selection for being promptly treated when similar situations happen in the future.
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http://dx.doi.org/10.1002/ccd.29433DOI Listing
December 2020

[Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience].

Authors:
Oriol Rodríguez-Leor Belén Cid-Álvarez Armando Pérez de Prado Xavier Rossello Soledad Ojeda Ana Serrador Ramón López-Palop Javier Martín-Moreiras José Ramón Rumoroso Ángel Cequier Borja Ibáñez Ignacio Cruz-González Rafael Romaguera Raúl Moreno Manuel Villa Rafael Ruíz-Salmerón Francisco Molano Carlos Sánchez Erika Muñoz-García Luís Íñigo Juan Herrador Antonio Gómez-Menchero Antonio Gómez-Menchero Juan Caballero Soledad Ojeda Mérida Cárdenas Livia Gheorghe Jesús Oneto Francisco Morales Félix Valencia José Ramón Ruíz José Antonio Diarte Pablo Avanzas Juan Rondán Vicente Peral Lucía Vera Pernasetti Julio Hernández Francisco Bosa Pedro Luís Martín Lorenzo Francisco Jiménez José M de la Torre Hernández Jesús Jiménez-Mazuecos Fernando Lozano José Moreu Enrique Novo Javier Robles Javier Martín Moreiras Felipe Fernández-Vázquez Ignacio J Amat-Santos Joan Antoni Gómez-Hospital Joan García-Picart Bruno García Del Blanco Ander Regueiro Xavier Carrillo-Suárez Helena Tizón Mohsen Mohandes Juan Casanova Víctor Agudelo-Montañez Juan Francisco Muñoz Juan Franco Roberto Del Castillo Pablo Salinas Jaime Elizaga Fernando Sarnago Santiago Jiménez-Valero Fernando Rivero Juan Francisco Oteo Eduardo Alegría-Barrero Ángel Sánchez-Recalde Valeriano Ruíz Eduardo Pinar Eduardo Pinar Ana Planas Bernabé López Ledesma Alberto Berenguer Agustín Fernández-Cisnal Pablo Aguar Francisco Pomar Miguel Jerez Francisco Torres Ricardo García Araceli Frutos Juan Miguel Ruíz Nodar Koldobika García Roberto Sáez Alfonso Torres Miren Tellería Mario Sadaba José Ramón López Mínguez Juan Carlos Rama Merchán Javier Portales Ramiro Trillo Guillermo Aldama Saleta Fernández Melisa Santás María Pilar Portero Pérez

Rev Esp Cardiol 2020 Dec 9;73(12):994-1002. Epub 2020 Oct 9.

Hospital San Pedro de Logroño.

Introduction And Objectives: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.

Methods: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.

Results: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes,  < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14;  = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.

Conclusions: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
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http://dx.doi.org/10.1016/j.recesp.2020.07.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546233PMC
December 2020

Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience.

Authors:
Oriol Rodríguez-Leor Belén Cid-Álvarez Armando Pérez de Prado Xavier Rossello Soledad Ojeda Ana Serrador Ramón López-Palop Javier Martín-Moreiras José Ramón Rumoroso Ángel Cequier Borja Ibáñez Ignacio Cruz-González Rafael Romaguera Raúl Moreno Manuel Villa Rafael Ruíz-Salmerón Francisco Molano Carlos Sánchez Erika Muñoz-García Luís Íñigo Juan Herrador Antonio Gómez-Menchero Antonio Gómez-Menchero Juan Caballero Soledad Ojeda Mérida Cárdenas Livia Gheorghe Jesús Oneto Francisco Morales Félix Valencia José Ramón Ruíz José Antonio Diarte Pablo Avanzas Juan Rondán Vicente Peral Lucía Vera Pernasetti Julio Hernández Francisco Bosa Pedro Luís Martín Lorenzo Francisco Jiménez José M de la Torre Hernández Jesús Jiménez-Mazuecos Fernando Lozano José Moreu Enrique Novo Javier Robles Javier Martín Moreiras Felipe Fernández-Vázquez Ignacio J Amat-Santos Joan Antoni Gómez-Hospital Joan García-Picart Bruno García Del Blanco Ander Regueiro Xavier Carrillo-Suárez Helena Tizón Mohsen Mohandes Juan Casanova Víctor Agudelo-Montañez Juan Francisco Muñoz Juan Franco Roberto Del Castillo Pablo Salinas Jaime Elizaga Fernando Sarnago Santiago Jiménez-Valero Fernando Rivero Juan Francisco Oteo Eduardo Alegría-Barrero Ángel Sánchez-Recalde Valeriano Ruíz Eduardo Pinar Eduardo Pinar Ana Planas Bernabé López Ledesma Alberto Berenguer Agustín Fernández-Cisnal Pablo Aguar Francisco Pomar Miguel Jerez Francisco Torres Ricardo García Araceli Frutos Juan Miguel Ruíz Nodar Koldobika García Roberto Sáez Alfonso Torres Miren Tellería Mario Sadaba José Ramón López Mínguez Juan Carlos Rama Merchán Javier Portales Ramiro Trillo Guillermo Aldama Saleta Fernández Melisa Santás María Pilar Portero Pérez

Rev Esp Cardiol (Engl Ed) 2020 Dec 8;73(12):994-1002. Epub 2020 Sep 8.

Hospital San Pedro de Logroño.

Introduction And Objectives: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.

Methods: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.

Results: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.

Conclusions: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
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http://dx.doi.org/10.1016/j.rec.2020.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834732PMC
December 2020

AV block in a young patient secondary to cystic tumor of the auriculoventricular node.

Med Clin (Barc) 2020 Aug 17. Epub 2020 Aug 17.

Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España; Servicio de Cardiología, Hospital Universitario de Torrejón, Madrid, España.

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http://dx.doi.org/10.1016/j.medcli.2020.07.011DOI Listing
August 2020

Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve-Guided Revascularization Strategy.

JACC Cardiovasc Interv 2019 10;12(20):2035-2046

Hammersmith Hospital, Imperial College London, London, United Kingdom.

Objectives: This study sought to evaluate sex differences in procedural characteristics and clinical outcomes of instantaneous wave-free ratio (iFR)- and fractional flow reserve (FFR)-guided revascularization strategies.

Background: An iFR-guided strategy has shown a lower revascularization rate than an FFR-guided strategy, without differences in clinical outcomes.

Methods: This is a post hoc analysis of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate stenosis to guide Revascularization) study, in which 601 women and 1,891 men were randomized to iFR- or FFR-guided strategy. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization.

Results: Among the entire population, women had a lower number of functionally significant lesions per patient (0.31 ± 0.51 vs. 0.43 ± 0.59; p < 0.001) and less frequently underwent revascularization than men (42.1% vs. 53.1%; p < 0.001). There was no difference in mean iFR value according to sex (0.91 ± 0.09 vs. 0.91 ± 0.10; p = 0.442). However, the mean FFR value was lower in men than in women (0.83 ± 0.09 vs. 0.85 ± 0.10; p = 0.001). In men, an FFR-guided strategy was associated with a higher rate of revascularization than an iFR-guided strategy (57.1% vs. 49.3%; p = 0.001), but this difference was not observed in women (41.4% vs. 42.6%; p = 0.757). There was no difference in MACE rates between iFR- and FFR-guided strategies in both women (5.4% vs. 5.6%, adjusted hazard ratio: 1.10; 95% confidence interval: 0.50 to 2.43; p = 0.805) and men (6.6% vs. 7.0%, adjusted hazard ratio: 0.98; 95% confidence interval: 0.66 to 1.46; p = 0.919).

Conclusions: An FFR-guided strategy was associated with a higher rate of revascularization than iFR-guided strategy in men, but not in women. However, iFR- and FFR-guided strategies showed comparable clinical outcomes, regardless of sex. (Functional Lesion Assessment of Intermediate Stenosis to guide Revascularization [DEFINE-FLAIR]; NCT02053038).
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http://dx.doi.org/10.1016/j.jcin.2019.06.035DOI Listing
October 2019

Comparison of Major Adverse Cardiac Events Between Instantaneous Wave-Free Ratio and Fractional Flow Reserve-Guided Strategy in Patients With or Without Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial.

JAMA Cardiol 2019 09;4(9):857-864

Hammersmith Hospital, Imperial College London, London, England.

Importance: Invasive physiologic indices such as fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are used in clinical practice. Nevertheless, comparative prognostic outcomes of iFR-guided and FFR-guided treatment in patients with type 2 diabetes have not yet been fully investigated.

Objective: To compare 1-year clinical outcomes of iFR-guided or FFR-guided treatment in patients with and without diabetes in the Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularization (DEFINE-FLAIR) trial.

Design, Setting, And Participants: The DEFINE-FLAIR trial is a multicenter, international, randomized, double-blinded trial that randomly assigned 2492 patients in a 1:1 ratio to undergo either iFR-guided or FFR-guided coronary revascularization. Patients were eligible for trial inclusion if they had intermediate coronary artery disease (40%-70% diameter stenosis) in at least 1 native coronary artery. Data were analyzed between January 2014 and December 2015.

Interventions: According to the study protocol, iFR of 0.89 or less and FFR of 0.80 or less were used as criteria for revascularization. When iFR or FFR was higher than the prespecified threshold, revascularization was deferred.

Main Outcomes And Measures: The primary end point was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. The incidence of MACE was compared according to the presence of diabetes in iFR-guided and FFR-guided groups.

Results: Among the total trial population (2492 patients), 758 patients (30.4%) had diabetes. Mean age of the patients was 66 years, 76% were men (1868 of 2465), and 80% of patients presented with stable angina (1983 of 2465). In the nondiabetes population (68.5%; 1707 patients), iFR guidance was associated with a significantly higher rate of deferral of revascularization than the FFR-guided group (56.5% [n = 477 of 844] vs 46.6% [n = 402 of 863]; P < .001). However, it was not different between the 2 groups in the diabetes population (42.1% [n = 161 of 382] vs 47.1% [n = 177 of 376]; P = .15). At 1 year, the diabetes population showed a significantly higher rate of MACE than the nondiabetes population (8.6% vs 5.6%; adjusted hazard ratio [HR], 1.88; 95% CI, 1.28-2.64; P < .001). However, there was no significant difference in MACE rates between iFR-guided and FFR-guided groups in both the diabetes (10.0% vs 7.2%; adjusted HR, 1.33; 95% CI, 0.78-2.25; P = .30) and nondiabetes population (4.7% vs 6.4%; HR, 0.83; 95% CI, 0.51-1.35; P = .45) (interaction P = .25).

Conclusions And Relevance: The diabetes population showed significantly higher risk of MACE than the nondiabetes population, even with the iFR-guided or FFR-guided treatment. The iFR-guided and FFR-guided treatment showed comparable risk of MACE and provided equal safety in selecting revascularization target among patients with diabetes.

Trial Registration: ClinicalTrials.gov identifier: NCT02053038.
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http://dx.doi.org/10.1001/jamacardio.2019.2298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646975PMC
September 2019

Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.

J Am Coll Cardiol 2019 02;73(4):444-453

Hospital Clinico San Carlos and Universidad Complutense de Madrid, Madrid, Spain.

Background: Physicians are not always comfortable deferring treatment of a stenosis in the left anterior descending (LAD) artery because of the perception that there is a high risk of major adverse cardiac events (MACE). The authors describe, using the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) trial, MACE rates when LAD lesions are deferred, guided by physiological assessment using fractional flow reserve (FFR) or the instantaneous wave-free ratio (iFR).

Objectives: The purpose of this study was to establish the safety of deferring treatment in the LAD using FFR or iFR within the DEFINE-FLAIR trial.

Methods: MACE rates at 1 year were compared between groups (iFR and FFR) in patients whose physiological assessment led to LAD lesions being deferred. MACE was defined as a composite of cardiovascular death, myocardial infarction (MI), and unplanned revascularization at 1 year. Patients, and staff performing follow-up, were blinded to whether the decision was made with FFR or iFR. Outcomes were adjusted for age and sex.

Results: A total of 872 patients had lesions deferred in the LAD (421 guided by FFR, 451 guided by iFR). The event rate with iFR was significantly lower than with FFR (2.44% vs. 5.26%; adjusted HR: 0.46; 95% confidence interval [CI]: 0.22 to 0.95; p = 0.04). This was driven by significantly lower unplanned revascularization with iFR and numerically lower MI (unplanned revascularization: 2.22% iFR vs. 4.99% FFR; adjusted HR: 0.44; 95% CI: 0.21 to 0.93; p = 0.03; MI: 0.44% iFR vs. 2.14% FFR; adjusted HR: 0.23; 95% CI: 0.05 to 1.07; p = 0.06).

Conclusions: iFR-guided deferral appears to be safe for patients with LAD lesions. Patients in whom iFR-guided deferral was performed had statistically significantly lower event rates than those with FFR-guided deferral.
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http://dx.doi.org/10.1016/j.jacc.2018.10.070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354033PMC
February 2019

Endovascular Treatment of Recurrent Chylopericardium: In Vivo Demonstration of Chylopericardial Connections.

Rev Esp Cardiol (Engl Ed) 2019 Sep 15;72(9):786-788. Epub 2018 Dec 15.

Servicio de Cirugía Torácica, Hospital Universitario de Torrejón, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2018.11.008DOI Listing
September 2019

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 Syndromes.

JACC Cardiovasc Interv 2018 08;11(15):1437-1449

Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.

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 < 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.
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http://dx.doi.org/10.1016/j.jcin.2018.05.029DOI Listing
August 2018

[Accelerated atrioventricular junctional rhythm].

Arch Cardiol Mex 2017 Oct - Dec;87(4):349-351. Epub 2017 Sep 12.

Servicio de Cardiología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Unidad de Cardiología, Hospital Ruber Internacional, Madrid, España; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España.

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http://dx.doi.org/10.1016/j.acmx.2017.07.007DOI Listing
September 2018

Accordion music from the heart: dynamic coronary artery compression.

Coron Artery Dis 2017 11;28(7):624

Departments of aCardiology bOpthalmology, Hospital Universitario de Torrejón cFaculty of Health Science, Universidad Francisco de Vitoria dCardiology Unit, Hospital Ruber Internacional, Madrid, Spain.

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http://dx.doi.org/10.1097/MCA.0000000000000506DOI Listing
November 2017

[Age and cardiopulmonary resuscitation wishes of patients with heart disease].

Rev Esp Geriatr Gerontol 2017 Jan - Feb;52(1):57-58. Epub 2016 Oct 27.

Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Alcobendas, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España.

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http://dx.doi.org/10.1016/j.regg.2016.08.005DOI Listing
June 2018

Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI.

N Engl J Med 2017 05 18;376(19):1824-1834. Epub 2017 Mar 18.

From Hammersmith Hospital (J.E.D., S.S., R.A.-L., R.P., S.S.N., I.S.M., P.S.) and Royal Brompton Hospital (C.D.M.), Imperial College London, Cancer Research UK and University College London Cancer Trials Centre (H.-M.D.), London, Conquest Hospital, St. Leonards-on-Sea (R.T.G.), Royal Devon and Exeter Hospital and University of Exeter, Exeter (A.S.P.S.), Royal Bournemouth General Hospital, Bournemouth (S.T.), Essex Cardiothoracic Centre, Basildon (K.T.), Anglia Ruskin University, Chelmsford (K.T.), and John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford (R.K.K.) - all in the United Kingdom; Royal North Shore Hospital, Sydney (R.B.), Flinders University, Adelaide, SA (S.J.L.), Prince Charles Hospital, Brisbane, QLD (D.W.), and MonashHeart and Monash University, Melbourne, VIC (J. Sapontis) - all in Australia; Imelda Hospital, Bonheiden (L.J.), and Antwerp University Hospital, Antwerp (C.J.V.) - both in Belgium; Ain Shams University, Cairo (A.K.); Helsinki University Hospital, Helsinki (M.L.); Institut Coeur Poumon, Lille University Hospital, and INSERM Unité 1011, Lille, France (E.V.B.); Charite Campus Virchow Klinikum, Universitaetsmedizin, Berlin (F.K.), Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz (W.B.), Sana Klinikum Lichtenberg, Lichtenberg (O.G.), and Klinikum Oldenburg, European Medical School, Carl von Ossietzky University, Oldenburg (T.H.) - all in Germany; University Magna Graecia, Catanzaro (C.I.), Catholic University of the Sacred Heart, Rome (G.N.), University Hospital Verona, Verona (F.R.), and University of Florence, Florence (C.D.M.) - all in Italy; Tokyo Medical University, Tokyo (N.T.), Fukuoka Sannou Hospital, Fukuoka (H.Y.), Aichi Medical University Hospital, Aichi (H.T.), Fukuyama Cardiovascular Hospital, Fukuyama (Y.K.), and Gifu Heart Center, Gifu (H.M.) - all in Japan; Pauls Stradins Clinical University Hospital, Riga, Latvia (A.E.); Hospital Garcia de Horta (H.V.) and Hospital Santa Maria (P.C.S.), Lisbon. and Hospital Prof. Doutor Fernando Fonseca, Amadora (S.B.B.) - all in Portugal; King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi Arabia (A.A.); Sunninghill Hospital, Johannesburg (F.H.); Seoul National University Hospital, Seoul (B.-K.K.), Keimyung University Dongsan Medical Center, Daegu (C.-W.N.), Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.), and Inje University Ilsan Paik Hospital, Daehwa-Dong (J.-H.D.) - all in South Korea; Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona (S.B.); Hospital Universitario de Torrejón and Universidad Francisco de Vitoria (E.A.-B.) and Hospital Clinico San Carlos and Universidad Complutense de Madrid (J.E.), Madrid; Amphia Hospital, Breda (M.M.), and AMC Heart Center, Academic Medical Center (J.J.P.), and VU University Medical Center (N.R.), Amsterdam - all in the Netherlands; Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey (M.S.); Emory University, Atlanta (H.S.); Colorado Heart and Vascular, Lakewood (J.A.); Veterans Affairs Long Beach Healthcare System, Long Beach, CA (A.H.S.); Washington University School of Medicine, St. Louis (J. Singh); Stony Brook University Medical Center, New York (A.J.); and Duke University, Durham, NC (M.R.P.).

Background: Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR.

Methods: We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization. The primary end point was the 1-year risk of major adverse cardiac events, which were a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization. The trial was designed to show the noninferiority of iFR to FFR, with a margin of 3.4 percentage points for the difference in risk.

Results: At 1 year, the primary end point had occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to 1.8; P<0.001 for noninferiority; hazard ratio, 0.95; 95% CI, 0.68 to 1.33; P=0.78). The risk of each component of the primary end point and of death from cardiovascular or noncardiovascular causes did not differ significantly between the groups. The number of patients who had adverse procedural symptoms and clinical signs was significantly lower in the iFR group than in the FFR group (39 patients [3.1%] vs. 385 patients [30.8%], P<0.001), and the median procedural time was significantly shorter (40.5 minutes vs. 45.0 minutes, P=0.001).

Conclusions: Coronary revascularization guided by iFR was noninferior to revascularization guided by FFR with respect to the risk of major adverse cardiac events at 1 year. The rate of adverse procedural signs and symptoms was lower and the procedural time was shorter with iFR than with FFR. (Funded by Philips Volcano; DEFINE-FLAIR ClinicalTrials.gov number, NCT02053038 .).
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http://dx.doi.org/10.1056/NEJMoa1700445DOI Listing
May 2017

[Prevalence of sleep apnea disorders among high-risk patients included in a cardiac rehabilitation program].

Arch Cardiol Mex 2017 Jan - Mar;87(1):92-94. Epub 2016 Dec 9.

Servicio de Neumología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.

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http://dx.doi.org/10.1016/j.acmx.2016.10.002DOI Listing
April 2017

[Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension].

Arch Cardiol Mex 2017 Apr - Jun;87(2):172-174

Servicio de Medicina Interna, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.

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http://dx.doi.org/10.1016/j.acmx.2016.06.009DOI Listing
May 2018

The 2011-2012 pilot European Society of Cardiology Sentinel Registry of Transcatheter Aortic Valve Implantation: 12-month clinical outcomes.

EuroIntervention 2016 May;12(1):79-87

Centre Hospitalier Universitaire (CHU) Brest, Brest, France.

Aims: Our aim was to assess one-year outcomes of patients enrolled in the pilot European Sentinel Registry of Transcatheter Aortic Valve Implantation (TAVI).

Methods And Results: One-year outcomes of 4,571 patients (81.4±7.2 years, 2,291 [50.1%] male) receiving TAVI with the SAPIEN XT (57.3%) or CoreValve prosthesis at 137 European centres were analysed using Kaplan-Meier and Cox proportional hazards regression techniques. At one year, 3,341 patients were alive, 821 had died, and 409 were lost to follow-up. Of 2,125 patients who underwent functional assessment, 1,916 (90%) were in New York Heart Association (NYHA) Class I/II at one year, with functional improvement from baseline noted in 1,682 patients (88%). One-year survival based on 4,564 patients was estimated at 79.1%. Independent baseline predictors of mortality were increasing age and logistic EuroSCORE, the presence of NYHA III/IV, chronic obstructive pulmonary disease, and atrial fibrillation. Female gender was associated with a 4% survival benefit at one year. Vascular access routes other than transfemoral were associated with poorer survival. Procedural failure and major periprocedural complications had an adverse impact on survival.

Conclusions: Contemporary European experience attests to the effectiveness of routine TAVI in unselected elderly patients.
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http://dx.doi.org/10.4244/EIJV12I1A15DOI Listing
May 2016

Expectations of Survival Following Cardiopulmonary Resuscitation. Predictions and Wishes of Patients With Heart Disease.

Rev Esp Cardiol (Engl Ed) 2016 Jun 14;69(6):613-5. Epub 2016 Apr 14.

Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.02.011DOI Listing
June 2016

Cardiovascular Safety in Drug Development: A Role for Endothelial Function Tests.

J Cardiovasc Pharmacol Ther 2016 11 23;21(6):507-515. Epub 2016 Mar 23.

Department of Cardiology, Hospital Universitario de Torrejon, Madrid, Spain Facultad de Ciencias Biosanitarias, Universidad Francisco de Vitoria, Madrid, Spain.

As drug development becomes a long and demanding process, it might also become a barrier to medical progress. Drug safety concerns are responsible for many of the resources consumed in launching a new drug. Despite the money and time expended on it, a significant number of drugs are withdrawn years or decades after being in the market. Cardiovascular toxicity is one of the major reasons for those late withdrawals, meaning that many patients are exposed to unexpected serious cardiovascular risks. It seems that current methods to assess cardiovascular safety are imperfect, so new approaches to avoid the exposure to those undesirable effects are quite necessary. Endothelial dysfunction is the earliest detectable pathophysiological abnormality, which leads to the development of atherosclerosis, and it is also an independent predictor for major cardiovascular events. Endothelial toxicity might be the culprit of the cardiovascular adverse effects observed with a significant number of drugs. In this article, we suggest the regular inclusion of the best validated and less invasive endothelial function tests in the clinical phases of drug development in order to facilitate the development of drugs with safer cardiovascular profiles.
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http://dx.doi.org/10.1177/1074248416639719DOI Listing
November 2016

Complex anatomy making it difficult for left atrial appendage closure.

Cardiovasc Revasc Med 2016 Mar 24;17(2):146-7. Epub 2015 Dec 24.

Department of Cardiology, Monteprincipe University Hospital, Madrid, Spain.

Left atrial appendage closure is a useful technique for patients at high thromboembolic risk and contraindications for oral anticoagulation therapy. However, it can be challenging when anatomical difficulties are encountered. We present a unique case of atypical appendage uptake and how we completed the procedure.
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http://dx.doi.org/10.1016/j.carrev.2015.12.006DOI Listing
March 2016

Local and general anaesthesia do not influence outcome of transfemoral aortic valve implantation.

Int J Cardiol 2014 Dec 28;177(2):448-54. Epub 2014 Sep 28.

NIHR Cardiovascular BRU, Royal Brompton Hospital, London, United Kingdom. Electronic address:

Background: There is great variability for the type of anaesthesia used during TAVI, with no clear consensus coming from comparative studies or guidelines. We sought to detect regional differences in the anaesthetic management of patients undergoing transcatheter aortic valve implantation (TAVI) in Europe and to evaluate the relationship between type of anaesthesia and in-hospital and 1 year outcome.

Methods: Between January 2011 and May 2012 the Sentinel European TAVI Pilot Registry enrolled 2807 patients treated via a transfemoral approach using either local (LA-group, 1095 patients, 39%) or general anaesthesia (GA-group, 1712 patients, 61%).

Results: A wide variation in LA use was evident amongst the 10 participating countries. The use of LA has increased over time (from a mean of 37.5% of procedures in the first year, to 57% in last 6 months, p<0.01). MI, major stroke as well as in-hospital death rate (7.0% LA vs 5.3% GA, p=0.053) had a similar incidence between groups, confirmed in multivariate regression analysis after adjusting for confounders. Dividing our population in tertiles according to the Log-EuroSCORE we found similar mortality under LA, whilst mortality was higher in the highest risk tertile under GA. Survival at 1 year, compared by Kaplan-Meier analysis, was similar between groups (log-rank: p=0.1505).

Conclusions: Selection of anaesthesia appears to be more influenced by national practice and operator preference than patient characteristics. In the absence of an observed difference in outcomes for either approach, there is no compelling argument to suggest that operators and centres should change their anaesthetic practice.
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http://dx.doi.org/10.1016/j.ijcard.2014.09.025DOI Listing
December 2014

Successful recanalization of a blind stumpless aorto-ostial left main chronic total occlusion.

Int J Cardiol 2014 Oct 13;176(3):e94-5. Epub 2014 Aug 13.

Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain.

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http://dx.doi.org/10.1016/j.ijcard.2014.07.295DOI Listing
October 2014

Mitral Regurgitation - A Multidisciplinary Challenge.

Eur Cardiol 2014 Jul;9(1):49-53

Interventional Cardiology, Klinik im Park, Hirslanden Zurich, Zurich, Switzerland.

Mitral regurgitation is an increasing valvular disease that represents a difficult management challenge. Surgical treatment for degenerative mitral regurgitation is the standard of care treatment. Percutaneous therapies have emerged rapidly over the past years as an option for treatment of mitral regurgitation for selected, predominantly high-risk patients. Catheter-based devices mimic these surgical approaches with less procedural risk. Mitraclip® implantation mimics the surgical edge-to-edge leaflet repair technique, reducing the regurgitant area. We review the increasing evidence with the Mitraclip device reported to date.
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http://dx.doi.org/10.15420/ecr.2014.9.1.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159436PMC
July 2014

Extended use of the GuideLiner in complex coronary interventions.

EuroIntervention 2015 Jul;11(3):325-35

International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom.

Aims: Challenging coronary anatomies including chronic total occlusions (CTO), extreme vessel tortuosity, diseased bypass grafts, and anomalous coronary arteries pose difficulties in coronary interventions. The GuideLiner is a monorail catheter originally developed to facilitate delivery of stents to target lesions in tortuous vessels. We conducted a study on the feasibility and safety of utilising this catheter in a wider array of complex coronary interventions.

Methods And Results: Consecutive patients undergoing coronary or peripheral interventions where a GuideLiner was used were recruited into this study. Patient demographics, lesion and vessel characteristics, procedural details and outcomes were prospectively entered into our database and analysed. From September 2009 to October 2011, 54 consecutive patients underwent coronary intervention in our institution using a GuideLiner; 21 out of 54 coronary applications were motivated by the need to increase support to cross CTOs, predominantly of the RCA. Anomalous or angulated take-off of the treatment vessels (31%), previously deployed proximal stents (15%), heavy proximal calcification (9%) and tortuosity (7%) accounted for the remaining reasons. One patient had successful renal denervation with the aid of a GuideLiner catheter. Procedural success was 98% in our series with no device-related periprocedural complications such as ostial dissection or myocardial necrosis.

Conclusions: The use of a GuideLiner facilitates the approach to complex coronary interventions including chronic total occlusion and saphenous vein graft intervention by providing greater back-up support and easier engagement of coronary ostia.
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http://dx.doi.org/10.4244/EIJY14M06_02DOI Listing
July 2015

Microchannels in recent chronic total occlusions assessed with frequency-domain optical coherence tomography.

Rev Esp Cardiol (Engl Ed) 2013 Nov 28;66(11):907. Epub 2012 Apr 28.

Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield Trust, London, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.rec.2012.01.018DOI Listing
November 2013

[Overweight is the main determinant of excessive increase of triglycerides after meals].

Med Clin (Barc) 2014 Aug 19;143(3):136-7. Epub 2013 Dec 19.

Servicio de Cardiología, Policlínica Gipuzkoa, San Sebastián, Guipúzcoa, España.

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http://dx.doi.org/10.1016/j.medcli.2013.10.005DOI Listing
August 2014

A coronary "tunnel": optical coherence tomography assessment after rotational atherectomy.

Catheter Cardiovasc Interv 2014 Apr 30;83(5):E171-3. Epub 2013 Nov 30.

Biomedical Cardiovascular Research Unit, Royal Brompton Hospital & Harefield Trust, London, United Kingdom.

A 81-year-old woman was admitted for exertional angina. Coronary angiogram revealed a severely calcific proximal circumflex lesion. Rotational atherectomy was performed with 1.5 and 1.75 burrs, obtaining a good angiographic result. Optical coherence tomography (OCT) assessment revealed a large dissection parallel to the true lumen. We implanted a 3.0 mm × 38 mm Xience Prime(®) stent and postdilated it with a 3.0-mm non-compliant balloon. Final OCT pullback showed mild malapposed struts with large lumen area. 3D-OCT reconstruction confirmed a large lumen after stent implantation.
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http://dx.doi.org/10.1002/ccd.24388DOI Listing
April 2014

Obstructive sleep apnea severity is associated with left ventricular mass independent of other cardiovascular risk factors in morbid obesity.

J Clin Sleep Med 2013 Nov 15;9(11):1165-71. Epub 2013 Nov 15.

Departments of Endocrinology and Nutrition.

Objective: To evaluate the relation between obstructive sleep apnea (OSA) and left ventricular mass (LVM) in morbid obesity and the influence of gender, menopausal status, anthropometry, body composition, hypertension, and other cardiovascular risk factors in this relationship.

Design: Cross-sectional descriptive study.

Methods: Polysomnographic and echocardiographic studies were performed in a cohort of 242 patients (86 men, 100 premenopausal (PreM) and 56 postmenopausal (PostM) women), with grade II obesity and above (BMI: 43.7 ± 0.4 kg/m(2)) to investigate OSA and LVM respectively. Anthropometry, body composition, glucose tolerance, and blood pressure were also recorded.

Results: OSA to different degrees was diagnosed in 76.2% of the patients (n: 166), its prevalence being 90.9% (n: 70) for men, and 76% (n: 38) and 63.8% (n: 58) for PostM and PreM women, respectively (p < 0.01). LVM excess was greatest for PostM women (90.2%), followed by men (81.9%) and PreM females (69.6%) (p < 0.01). LVM values increased in accordance to OSA severity (absence, 193.7 ± 6.9 g; mild, 192.6 ± 7.8 g; moderate, 240.5 ± 12.5 g; severe, 273.6 ± 14.6 g; p < 0.01). LVM magnitude correlated with the menopausal state, age, central adiposity, hypertension (HT), type 2 diabetes (DM), desaturation index (DI), and apnea-hypopnea index (AHI) (r = 0.41; p < 0.01). The relationship between LVM and AHI persisted in the multivariate analysis (β = 0.25; p < 0.05) after adjusting for age, gender, menopausal state, BMI, waist circumference, neck circumference, DI, fasting plasma glucose, DM, and HT. But if tobacco habits are included, the statistical difference disappears (β = 0.22; p = 0.06).

Conclusions: Morbid obesity is frequently associated with abnormal LVM, particularly in patients with OSA; this association is independent of HT, BMI, body composition, and other clinical factors, supporting a direct role of OSA on LVM in morbid obesity. This suggests that OSA and LVM might be taken as predictors of the cardiovascular risk in these patients.
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http://dx.doi.org/10.5664/jcsm.3160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805802PMC
November 2013

Predictors of stent strut malapposition in calcified vessels using frequency-domain optical coherence tomography.

J Invasive Cardiol 2013 Sep;25(9):429-34

NHLI Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, United Kingdom.

Background And Aims: Malapposition of stent struts to the arterial wall and suboptimal stent expansion have been linked with poor outcomes following percutaneous coronary intervention (PCI). The purpose of this study was to use optical coherence tomography (OCT) to investigate stent strut malapposition in relation to calcium distribution.

Methods And Results: Twenty-three PCI patients underwent OCT before and after stent deployment. Patient and procedural details and lesion characteristics - including the extent and depth of calcification - were measured, and the number of malapposed struts following final postdilatation was quantified. Patient and lesion characteristics associated with malapposition were assessed using univariate and multivariate analyses. The mean lesion length was 25.2 ± 10.8 mm, with a minimal lumen area (MLA) of 2.2 ± 1.2 mm². Eight percent of all stent struts were malapposed, most commonly in the proximal part of the stent. By univariate analysis, the percentage of malapposed struts was found to correlate with the circumferential extent of calcification (P=.04); however, no correlation was seen with the depth of calcification. Using multivariate analysis, the circumferential extent of vessel wall calcification was the only plaque feature found to correlate with the percentage of malapposed struts (P=.01).

Conclusions: Using OCT to assess vessel wall characteristics, the circumferential extent of superficial calcification seen, and not the depth, correlated well with the percentage of malapposed struts following PCI.
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September 2013