Imperial College London

Emeritus ProfessorKimFox

Faculty of MedicineNational Heart & Lung Institute

Emeritus Professor
 
 
 
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Contact

 

+44 (0)20 7594 7966kim.fox

 
 
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Assistant

 

Ms Deborah Curcher +44 (0)20 7594 7966

 
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Location

 

Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

551 results found

Blood Pressure Lowering Treatment Trialists' Collaboration, 2021, Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis., Lancet, Vol: 397, Pages: 1625-1636

BACKGROUND: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. FINDINGS: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 15

Journal article

Copland E, Canoy D, Nazarzadeh M, Bidel Z, Ramakrishnan R, Woodward M, Chalmers J, Teo KK, Pepine CJ, Davis BR, Kjeldsen S, Sundstrom J, Rahimi Ket al., 2021, Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis, LANCET ONCOLOGY, Vol: 22, Pages: 558-570, ISSN: 1470-2045

Journal article

Leiter L, Bhatt DL, McGuire DK, Teoh H, Fox K, Simon T, Mehta SR, Lev EI, Kiss RG, Dalby AJ, Bueno H, Ridderstrale W, Himmelmann A, Prats J, Liu Y, Lee JL, Amerena J, Kosiborod MN, Steg PGet al., 2021, Relationship between diabetes-related factors and the effects of ticagrelor plus aspirin in THEMIS and THEMIS-PCI, JACC - Journal of the American College of Cardiology, ISSN: 0735-1097

Journal article

Davies A, Fox K, Galassi AR, Banai S, Yla-Herttuala S, Luescher TFet al., 2021, Management of refractory angina: an update, EUROPEAN HEART JOURNAL, Vol: 42, Pages: 269-280C, ISSN: 0195-668X

Journal article

Mak K-H, Vidal-Petiot E, Young R, Sorbets E, Greenlaw N, Ford I, Tendera M, Ferrari R, Tardiff J-C, Udell JA, Escobedo J, Fox K, Steg PGet al., 2021, Prevalence of diabetic and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities, European Journal of Preventive Cardiology, ISSN: 2047-4873

Background: In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods: CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia and Africa in 2009-2010, and followed-up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischemia, or prior revascularisation procedure. Results: Among 32,694patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to approximately 60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome(cardiovascular death, myocardial infarction or stroke)with an adjusted hazard ratio of1.28(95% CI 1.18-1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion: In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes.

Journal article

Lüscher TF, Fox K, Hamm C, Carter RE, Taddei S, Simoons M, Crea Fet al., 2020, Scientific integrity: what a journal can and cannot do., European Heart Journal, Vol: 41, Pages: 4552-4555, ISSN: 0195-668X

Journal article

Gautier A, Ducrocq G, Ebez Y, Fox KM, Ferrari R, Ford I, Tardiff J-C, Feldman LJ, Steg Pet al., 2020, Cardiovascular risk of chronic coronary syndrome patients according to vascular phenotype, diabetes and smoking, European Journal of Preventive Cardiology, ISSN: 2047-4873

Journal article

Pavasini R, Camici PG, Crea F, Danchin N, Fox K, Manolis AJ, Marzilli M, Rosano GMC, Lopez-Sendon JL, Pinto F, Balla C, Ferrari Ret al., 2020, Anti-anginal drugs: Systematic review and clinical implications (vol 283, pg 55, 2019), INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 321, Pages: 23-23, ISSN: 0167-5273

Journal article

Darmon A, Ducrocq G, Jasilek A, Feldman L, Sorbets E, Ferrari R, Ford I, Tardiff J-C, Tendera M, Fox K, Steg PGet al., 2020, Use of risk scores to identify lower and higher risk subsets among COMPASS-eligible patients with chronic coronary syndromes. Insights from the CLARIFY Registry, Clinical Cardiology (Hoboken): an indexed and peer-reviewed journal for advances in the treatment of cardiovascular disease, ISSN: 0160-9289

Background:The COMPASS trial showed a reduction of ischemic events with low‐dose rivaroxaban and aspirin in chronic coronary syndromes (CCS) compared with aspirin alone, at the expense of increased bleeding.Hypothesis:The CHA2DS2VaSc Score, REACH Recurrent Ischemic (RIS), and REACH Bleeding Risk Score (BRS) could identify patients with a favorable trade‐off between ischemic and bleeding events, among COMPASS‐eligible patients.Methods:We identified the COMPASS‐eligible population within the CLARIFY registry (>30.000 patients with CCS). High‐bleeding risk patients (REACH BRS > 10) were excluded, as in the COMPASS trial. Patients were categorized as low (0–1) or high (≥ 2) CHA2DS2VaSc; low (0–12) or intermediate (13–19) REACH RIS, and low (0–6) or intermediate (7–10) REACH BRS. Ischemic outcome was the composite of cardiovascular death, myocardial infarction or stroke. Bleeding was defined as serious bleeding (haemorrhagic stroke, hospitalization for bleeding, transfusion).Results:The COMPASS‐eligible population comprised 5.142 patients with ischemic and bleeding outcome of 2.3 (2.1–2.5) and 0.5 (0.4–0.6) per 100 patient‐years, respectively. Patients with intermediate REACH RIS (n = 1934 [37.6%]) had the higher ischemic risk (3.0 [2.6–3.4]) with similar bleeding risk (0.5 [0.4–0.7]) as the overall population. Patients with low CHA2DS2VaSc (n = 229 [4.4%]) had a very low ischemic risk (0.6 [0.3–1.3]) with similar bleeding risk (0.5 [0.2–1.1]).Conclusions:Intermediate REACH RIS identified potential optimal candidates for adjunction of low‐dose rivaroxaban while patients with low CHA2DS2VaSc score .appears unlikely to benefit from the COMPASS regimen. None of the three risk scores predicted the occurrence of serious bleeding.

Journal article

Darmon A, Ducrocq G, Jasilek A, Feldman L, Sorbets E, Ferrari R, Ford I, Tardif J-C, Tendera M, Fox KM, Steg PGet al., 2020, Use of risk scores to identify lower and higher risk subsets among COMPASS-eligible patients with chronic coronary syndromes. Insights from the CLARIFY registry, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: WILEY, Pages: 58-65, ISSN: 0160-9289

Conference paper

Biscaglia S, Campo G, Fox K, Tardif JC, Tendera M, Greenlaw N, Ford I, Stanley B, Ferraris R, Steg PGet al., 2020, Prognosis in patients with prior myocardial infarction and PEGASUS-TIMI 54 criteria in the CLARIFY registry, Publisher: OXFORD UNIV PRESS, Pages: 1431-1431, ISSN: 0195-668X

Conference paper

Gautier A, Ducrocq G, Elbez Y, Ferrari R, Ford I, Fox KM, Tardif JC, Tendera M, Steg Get al., 2020, CCS patients with polyvascular disease are a high risk but heterogenous subset of patients: insights from the CLARIFY registry, Publisher: OXFORD UNIV PRESS, Pages: 1365-1365, ISSN: 0195-668X

Conference paper

Steg P, Bhatt DL, James SK, Darlington O, Hoskin L, Simons T, Fox K, Leiter LA, Mehta S, Harrington RA, Himmelmann A, Ridderstrale W, Andersson M, Mellstrom C, Mcewan Pet al., 2020, Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease with a history of PCI: an economic evaluation of THEMIS-PCI using a Swedish healthcare perpective, Publisher: OXFORD UNIV PRESS, Pages: 3538-3538, ISSN: 0195-668X

Conference paper

Ferrari R, Ford I, Fox K, Challeton JP, Correges A, Tendera M, Widimský P, Danchin N, ATPCI investigatorset al., 2020, Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial., Lancet, Vol: 396, Pages: 830-838

BACKGROUND: Angina might persist or reoccur despite successful revascularisation with percutaneous coronary intervention (PCI) and antianginal therapy. Additionally, PCI in stable patients has not been shown to improve survival compared with optimal medical therapy. Trimetazidine is an antianginal agent that improves energy metabolism of the ischaemic myocardium and might improve outcomes and symptoms of patients who recently had a PCI. In this study, we aimed to assess the long-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients who had a recent successful PCI. METHODS: We did a randomised, double-blind, placebo-controlled, event-driven trial of trimetazidine added to standard background therapy in patients who had undergone successful PCI at 365 centres in 27 countries across Europe, South America, Asia, and north Africa. Eligible patients were aged 21-85 years and had had either elective PCI for stable angina or urgent PCI for unstable angina or non-ST segment elevation myocardial infarction less than 30 days before randomisation. Patients were randomly assigned by an interactive web response system to oral trimetazidine 35 mg modified-release twice daily or matching placebo. Participants, study investigators, and all study staff were masked to treatment allocation. The primary efficacy endpoint was a composite of cardiac death; hospital admission for a cardiac event; recurrence or persistence of angina requiring an addition, switch, or increase of the dose of at least one antianginal drug; or recurrence or persistence of angina requiring a coronary angiography. Efficacy analyses were done according to the intention-to-treat principle. Safety was assessed in all patients who had at least one dose of study drug. This study is registered with the EU Clinical Trials Register (EudraCT 2010-022134-89). FINDINGS: From Sept 17, 2014, to June 15, 2016, 6007 patients were enrolled and randomly assigned to rece

Journal article

Ferrari R, Ford I, Fox K, Challeton JP, Correges A, Tendera M, Widimsky P, Danchin Net al., 2020, The efficacy and safety of trimetazidine in patients having been treated by percutaneous coronary intervention (ATPCI): Results of a randomised double-blind placebo-controlled trial, The Lancet, Vol: 396, Pages: 830-838, ISSN: 0140-6736

BackgroundAngina might persist or reoccur despite successful revascularisation with percutaneous coronary intervention (PCI) and antianginal therapy. Additionally, PCI in stable patients has not been shown to improve survival compared with optimal medical therapy. Trimetazidine is an antianginal agent that improves energy metabolism of the ischaemic myocardium and might improve outcomes and symptoms of patients who recently had a PCI. In this study, we aimed to assess the long-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients who had a recent successful PCI.MethodsWe did a randomised, double-blind, placebo-controlled, event-driven trial of trimetazidine added to standard background therapy in patients who had undergone successful PCI at 365 centres in 27 countries across Europe, South America, Asia, and north Africa. Eligible patients were aged 21–85 years and had had either elective PCI for stable angina or urgent PCI for unstable angina or non-ST segment elevation myocardial infarction less than 30 days before randomisation. Patients were randomly assigned by an interactive web response system to oral trimetazidine 35 mg modified-release twice daily or matching placebo. Participants, study investigators, and all study staff were masked to treatment allocation. The primary efficacy endpoint was a composite of cardiac death; hospital admission for a cardiac event; recurrence or persistence of angina requiring an addition, switch, or increase of the dose of at least one antianginal drug; or recurrence or persistence of angina requiring a coronary angiography. Efficacy analyses were done according to the intention-to-treat principle. Safety was assessed in all patients who had at least one dose of study drug. This study is registered with the EU Clinical Trials Register (EudraCT 2010-022134-89).FindingsFrom Sept 17, 2014, to June 15, 2016, 6007 patients were enrolled and randomly assigned to receiv

Journal article

Parma Z, Jasilek A, Greenlaw N, Ferrari R, Ford I, Tardiff J-C, Fox K, Tendera Met al., 2020, Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry, European Journal of Heart Failure, Vol: 22, Pages: 804-812, ISSN: 1388-9842

AimThe contemporary incidence of heart failure (HF) in patients with chronic coronary syndrome is unclear. We aimed to study the incidence and predictors of cardiovascular (CV) death, HF hospitalization or new‐onset HF not requiring hospitalization, in patients included in the CLARIFY registry.Methods and resultsCLARIFY is a contemporary, international registry of ambulatory patients with chronic coronary artery disease, conducted in 45 countries. At baseline, data on demographics, ethnicity, CV risk factors, medical history, cardiac parameters and medication were collected. Patients were followed up yearly up to 5 years. In this analysis, 26 769 patients with no HF history were included. At 5‐year follow‐up, 4393 patients (16.4%) reached the primary endpoint comprising CV death, HF hospitalization, or new‐onset HF. Only 16.7% of them (n = 732) required hospitalization for HF. All‐cause death occurred in 6.6% of patients (61.4% were CV). Age over 70 years, left ventricular ejection fraction <50%, Canadian Cardiovascular Society class ≥2 angina, atrial fibrillation or paced rhythm on the ECG, body mass index <20 kg/m2, and a history of stroke, were the most robust predictors of the primary outcome. Age <50 years, Asian ethnicity, and percutaneous revascularization were negative predictors of the outcome.ConclusionA sizeable proportion of patients with chronic coronary syndrome develop HF, which only infrequently requires hospitalization. Early identification of patients with HF may lead to early treatment, and help to further decrease mortality and morbidity. This concept needs confirmation in future studies.

Journal article

Bouabdallaoui N, Messas N, Greenlaw N, Ferrari R, Ford I, Fox KM, Tendera M, Naidoo DP, Hassager C, Steg PG, Tardif J-Cet al., 2020, Impact of smoking on cardiovascular outcomes in patients with stable coronary artery disease, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, ISSN: 2047-4873

Journal article

Biscaglia S, Campo G, Sorbets E, Ford I, Fox K, Greenlaw N, Parkhomenko O, Tardif J-C, Tavazzi L, Tendera M, Wetherall K, Ferrari R, Steg Get al., 2020, Relationship between physical activity and long-term outcomes in patients with stable coronary artery disease, European Journal of Preventive Cardiology, Vol: 27, Pages: 426-436, ISSN: 2047-4873

AIMS To ascertain the relationship between level of physical activity and outcomes and to discriminate the determinants of physical activity performance or avoidance.METHODS CLARIFY is an international prospective registry of 32370 consecutive outpatients with stable coronary artery disease who were followed for up to 5 years. Patients were grouped according to the level and frequency of physical activity: i) sedentary (n=5223; 16.1%); ii) only light physical activity most weeks (light; n=16634; 51.4%); iii) vigorous physical activity once or twice per week (vigorous ≤2×; n=5427; 16.8%); iv) vigorous physical activity three or more times per week (vigorous >2×; n=5086; 15.7%). The primary outcome was the composite of cardiovascular death, myocardial infarction, and stroke.RESULTS Patients performing vigorous physical activity ≤2× had the lowest risk of the primary outcome (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.71-0.93; P = .0031) taking the light group as reference. Engaging in more frequent exercise did not result in further outcome benefit. All-cause death, cardiovascular death, and stroke occurred less frequently in patients performing vigorous physical activity ≤2×. However, the rate of myocardial infarction was comparable between the four physical activity groups. Female sex, peripheral artery disease, diabetes, previous myocardial infarction or stroke, pulmonary disease, and body mass index all emerged as independent predictors of lower physical activity.CONCLUSION Vigorous physical activity once or twice per week was associated with superior cardiac outcomes compared to patients performing no or a low level of physical activity in outpatients with stable coronary artery disease.

Journal article

Ford I, Robertson M, Greenlaw N, Bauters C, Lemesle G, Sorbets E, Ferrari R, Tardif J-C, Tendera M, Fox K, Steg PG, CLARIFY investigatorset al., 2020, Simple risk models to predict cardiovascular death in patients with stable coronary artery disease., Eur Heart J Qual Care Clin Outcomes

AIMS: Risk estimation is important to motivate patients to adhere to treatment and to identify those in whom additional treatments may be warranted and expensive treatments might be most cost effective. Our aim was to develop a simple risk model based on readily available risk factors for patients with stable coronary artery disease. METHODS AND RESULTS: Models were developed in the CLARIFY registry of patients with stable coronary artery disease, first incorporating only simple clinical variables and then with the inclusion of assessments of left ventricular function, estimated glomerular filtration rate and haemoglobin levels. The outcome of cardiovascular death over approximately 5 years was analysed using a Cox proportional hazards model. Calibration of the models was assessed in an external study, the CORONOR registry of patients with stable coronary disease. We provide formulae for calculation of the risk score and simple integer points-based versions of the scores with associated look-up risk tables. RESULTS: Only the models based on simple clinical variables provided both good c-statistics (0.74 in CLARIFY and 0.80 or over in CORONOR), with no lack of calibration in the external dataset. CONCLUSION: Our preferred model based on ten readily available variables (age, diabetes, smoking, heart failure symptom status and histories of atrial fibrillation or flutter, myocardial infarction, peripheral arterial disease, stroke, percutaneous coronary intervention and hospitalization for heart failure) had good discriminatory power and fitted well in an external dataset.

Journal article

Vidal-Petiot E, Greenlaw N, Kalra PR, Garcia-Moll X, Tardif J-C, Ford I, Zamorano J, Ferrari R, Tendera M, Fox KM, Steg PGet al., 2020, Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry, JOURNAL OF CLINICAL MEDICINE, Vol: 9

Journal article

Mahmoudi M, Nicholas Z, Nuttall J, Bresser M, Maishman T, Berry C, Hlatky MA, Douglas P, Rajani R, Fox K, Curzen Net al., 2019, Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: Rationale and design of the FORECAST trial, Cardiovascular Revascularization Medicine, ISSN: 1553-8389

BackgroundFractional flow reserve measurement based on computed tomography (FFRCT) is a novel, well validated, non-invasive method for determining the presence and extent of coronary artery disease (CAD) combined with a physiological assessment of vessel-specific ischemia in patients with chest pain. Previous studies indicate that FFRCT reduces the uptake of invasive angiography that shows no significant CAD, without compromising patient safety. The clinical effectiveness and economic impact of using FFRCT instead of other tests in the initial evaluation of patients with stable chest pain has not been tested in a randomized trial.MethodsThe FORECAST trial will randomise 1400 patients with stable chest pain to receive either FFRCT or routine clinical assessment as directed by the National Institute for Health and Care Excellence (NICE) CG95 guideline for Chest Pain of Recent Onset. The primary endpoint will be resource utilisation over the subsequent nine months, including non-invasive cardiac investigations, invasive coronary angiography, coronary revascularization, hospitalization for cardiac events, and the use of cardiac medications. Key pre-specified secondary endpoints will be major adverse cardiac events, angina severity, quality of life, patient satisfaction, time to definitive management plan, time to completion of initial evaluation, number of hospital attendances, and working days lost in patients who are in employment.ConclusionThe FORECAST randomized trial will assess the clinical and economic outcomes of using FFRCT as the primary test to evaluate patients presenting with stable chest pain.

Journal article

Vazir A, Westaby S, Fox K, 2019, Response to the commentary from Bisbal et al., titled 'Adipose graft transposition procedure: towards a novel strategy for myocardial scar and fibrosis reduction', EUROPEAN HEART JOURNAL, Vol: 40, Pages: 3573-3573, ISSN: 0195-668X

Journal article

Fox K, 2019, Angina due to obstructive coronary artery disease with type 2 diabetes., Eur Heart J Suppl, Vol: 21, Pages: G26-G27, ISSN: 1520-765X

Journal article

Fox K, 2019, Angina due to hypertension and dyslipidaemia., European Heart Journal Supplements, Vol: 21, Pages: G10-G10, ISSN: 1520-765X

Journal article

Fox K, 2019, Angina due to high heart rate., European Heart Journal Supplements, Vol: 21, Pages: G4-G4, ISSN: 1520-765X

Journal article

Steg PG, Bhatt DL, Simon T, Fox K, Mehta SR, Harrington RA, Held C, Andersson M, Himmelmann A, Ridderstråle W, Leonsson-Zachrisson M, Liu Y, Opolski G, Zateyshchikov D, Ge J, Nicolau JC, Corbalán R, Cornel JH, Widimský P, Leiter LA, THEMIS Steering Committee and Investigatorset al., 2019, Ticagrelor in patients with stable coronary disease and diabetes., New England Journal of Medicine, Vol: 381, Pages: 1309-1320, ISSN: 0028-4793

BACKGROUND: Patients with stable coronary artery disease and diabetes mellitus who have not had a myocardial infarction or stroke are at high risk for cardiovascular events. Whether adding ticagrelor to aspirin improves outcomes in this population is unclear. METHODS: In this randomized, double-blind trial, we assigned patients who were 50 years of age or older and who had stable coronary artery disease and type 2 diabetes mellitus to receive either ticagrelor plus aspirin or placebo plus aspirin. Patients with previous myocardial infarction or stroke were excluded. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was major bleeding as defined by the Thrombolysis in Myocardial Infarction (TIMI) criteria. RESULTS: A total of 19,220 patients underwent randomization. The median follow-up was 39.9 months. Permanent treatment discontinuation was more frequent with ticagrelor than placebo (34.5% vs. 25.4%). The incidence of ischemic cardiovascular events (the primary efficacy outcome) was lower in the ticagrelor group than in the placebo group (7.7% vs. 8.5%; hazard ratio, 0.90; 95% confidence interval [CI], 0.81 to 0.99; P = 0.04), whereas the incidence of TIMI major bleeding was higher (2.2% vs. 1.0%; hazard ratio, 2.32; 95% CI, 1.82 to 2.94; P<0.001), as was the incidence of intracranial hemorrhage (0.7% vs. 0.5%; hazard ratio, 1.71; 95% CI, 1.18 to 2.48; P = 0.005). There was no significant difference in the incidence of fatal bleeding (0.2% vs. 0.1%; hazard ratio, 1.90; 95% CI, 0.87 to 4.15; P = 0.11). The incidence of an exploratory composite outcome of irreversible harm (death from any cause, myocardial infarction, stroke, fatal bleeding, or intracranial hemorrhage) was similar in the ticagrelor group and the placebo group (10.1% vs. 10.8%; hazard ratio, 0.93; 95% CI, 0.86 to 1.02). CONCLUSIONS: In patients with stable coronary artery disea

Journal article

Darmon A, Ducrocq G, Jasilek A, Juliard JM, Sorbets E, Ferrari R, Ford I, Tardif JC, Fox KM, Steg PGet al., 2019, Frequency, management and outcomes of patients with stable coronary artery disease eligible for COMPASS. An analysis of the CLARIFY registry, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 1934-1934, ISSN: 0195-668X

Conference paper

Darmon A, Ducrocq G, Elbez Y, Sorbets E, Ferrari R, Ford I, Tardif JC, Tendera M, Fox KM, Steg PGet al., 2019, Prevalence, incidence and prognostic implications of left bundle branch block in patients with stable coronary artery disease. an analysis from the CLARIFY registry, Congress of the European-Society-of-Cardiology (ESC) / World Congress of Cardiology, Publisher: OXFORD UNIV PRESS, Pages: 1290-1290, ISSN: 0195-668X

Conference paper

Bhatt DL, Steg PG, Mehta SR, Leiter LA, Simon T, Fox K, Held C, Andersson M, Himmelmann A, Ridderstråle W, Chen J, Song Y, Diaz R, Goto S, James SK, Ray KK, Parkhomenko AN, Kosiborod MN, McGuire DK, Harrington RA, THEMIS Steering Committee and Investigatorset al., 2019, Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial., The Lancet, Vol: 394, Pages: 1169-1180, ISSN: 0140-6736

BACKGROUND: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. METHODS: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). FINDINGS: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8-3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74-0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, pinteraction=0·16). The proportion of patients with cardiovascular death was similar in b

Journal article

Sorbets E, Fox KM, Elbez Y, Danchin N, Dorian P, Ferrari R, Ford I, Greenlaw N, Kalra PR, Parma Z, Shalnova S, Tardif J-C, Tendera M, Zamorano JL, Vidal-Petiot E, Steg PGet al., 2019, Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry, European Heart Journal, Vol: 41, Pages: 347-356, ISSN: 0195-668X

AimsOver the last decades, the profile of chronic coronary syndrome has changed substantially. We aimed to determine characteristics and management of patients with chronic coronary syndrome in the contemporary era, as well as outcomes and their determinants.Methods and resultsData from 32 703 patients (45 countries) with chronic coronary syndrome enrolled in the prospective observational CLARIFY registry (November 2009 to June 2010) with a 5-year follow-up, were analysed. The primary outcome [cardiovascular death or non-fatal myocardial infarction (MI)] 5-year rate was 8.0% [95% confidence interval (CI) 7.7–8.3] overall [male 8.1% (7.8–8.5); female 7.6% (7.0–8.3)]. A cox proportional hazards model showed that the main independent predictors of the primary outcome were prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina, and peripheral artery disease. There was an interaction between angina and prior MI (P = 0.0016); among patients with prior MI, angina was associated with a higher primary event rate [11.8% (95% CI 10.9–12.9) vs. 8.2% (95% CI 7.8–8.7) in patients with no angina, P < 0.001], whereas among patients without prior MI, event rates were similar for patients with [6.3% (95% CI 5.4–7.3)] or without angina [6.4% (95% CI 5.9–7.0)], P > 0.99. Prescription rates of evidence-based secondary prevention therapies were high.ConclusionThis description of the spectrum of chronic coronary syndrome patients shows that, despite high rates of prescription of evidence-based therapies, patients with both angina and prior MI are an easily identifiable high-risk group who may deserve intensive treatment.

Journal article

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