Publications
207 results found
Al-Lamee R, Thompson D, Dehbi H-M, et al., 2018, Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial, Lancet, Vol: 391, Pages: 31-40, ISSN: 0140-6736
BACKGROUND: Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. METHODS: ORBITA is a blinded, multicentre randomised trial of PCI versus a placebo procedure for angina relief that was done at five study sites in the UK. We enrolled patients with severe (≥70%) single-vessel stenoses. After enrolment, patients received 6 weeks of medication optimisation. Patients then had pre-randomisation assessments with cardiopulmonary exercise testing, symptom questionnaires, and dobutamine stress echocardiography. Patients were randomised 1:1 to undergo PCI or a placebo procedure by use of an automated online randomisation tool. After 6 weeks of follow-up, the assessments done before randomisation were repeated at the final assessment. The primary endpoint was difference in exercise time increment between groups. All analyses were based on the intention-to-treat principle and the study population contained all participants who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02062593. FINDINGS: ORBITA enrolled 230 patients with ischaemic symptoms. After the medication optimisation phase and between Jan 6, 2014, and Aug 11, 2017, 200 patients underwent randomisation, with 105 patients assigned PCI and 95 assigned the placebo procedure. Lesions had mean area stenosis of 84·4% (SD 10·2), fractional flow reserve of 0·69 (0·16), and instantaneous wave-free ratio of 0·76 (0·22). There was no significant difference in the primary endpoint of exercise time increment between groups (PCI minus placebo 16·6 s, 95% CI -8·9 to 42·0, p=0·200). There were no deaths. Serious adverse events included four pressure-wire related complications in the placebo group, which required PCI, and five major bleeding
Cook CM, Petraco R, Davies JE, 2018, Coronary Computed Tomography-Based Fractional FlowReserve: A Rapidly Developing Field Reply, JAMA CARDIOLOGY, Vol: 3, Pages: 87-88, ISSN: 2380-6583
De Rosa S, Polimeni A, Petraco R, et al., 2018, Diagnostic Performance of the Instantaneous Wave-Free Ratio: Comparison With Fractional Flow Reserve, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 11, ISSN: 1941-7640
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- Citations: 33
Cook CM, Jeremias A, Petraco R, et al., 2017, Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements, JACC: Cardiovascular Interventions, Vol: 10, Pages: 2514-2524, ISSN: 1936-8798
ObjectivesThe study sought to determine the coronary flow characteristics of angiographically intermediate stenoses classified as discordant by fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).BackgroundDiscordance between FFR and iFR occurs in up to 20% of cases. No comparisons have been reported between the coronary flow characteristics of FFR/iFR discordant and angiographically unobstructed vessels.MethodsBaseline and hyperemic coronary flow velocity and coronary flow reserve (CFR) were compared across 5 vessel groups: FFR+/iFR+ (108 vessels, n = 91), FFR–/iFR+ (28 vessels, n = 24), FFR+/iFR– (22 vessels, n = 22), FFR–/iFR– (208 vessels, n = 154), and an unobstructed vessel group (201 vessels, n = 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study).ResultsFFR disagreed with iFR in 14% (50 of 366). Baseline flow velocity was similar across all 5 vessel groups, including the unobstructed vessel group (p = 0.34 for variance). In FFR+/iFR– discordants, hyperemic flow velocity and CFR were similar to both FFR–/iFR– and unobstructed groups; 37.6 (interquartile range [IQR]: 26.1 to 50.4) cm/s vs. 40.0 [IQR: 29.7 to 52.3] cm/s and 42.2 [IQR: 33.8 to 53.2] cm/s and CFR 2.36 [IQR: 1.93 to 2.81] vs. 2.41 [IQR: 1.84 to 2.94] and 2.50 [IQR: 2.11 to 3.17], respectively (p > 0.05 for all). In FFR–/iFR+ discordants, hyperemic flow velocity, and CFR were similar to the FFR+/iFR+ group; 28.2 (IQR: 20.5 to 39.7) cm/s versus 23.5 (IQR: 16.4 to 34.9) cm/s and CFR 1.44 (IQR: 1.29 to 1.85) versus 1.39 (IQR: 1.06 to 1.88), respectively (p > 0.05 for all).ConclusionsFFR/iFR disagreement was explained by differences in hyperemic coronary flow velocity. Furthermore, coronary stenoses classified as FFR+/iFR– demonstrated similar coronary flow characteristics to angiographically unobstructed vessels.
Bennett J, Lucio DA, Frame A, et al., 2017, Stroke post-transcatheter aortic valve insertion (post-TAVI): risk factors, management and outcomes, Publisher: SAGE PUBLICATIONS LTD, Pages: 22-22, ISSN: 1747-4930
Cook CM, Petraco R, Shun-Shin MJ, 2017, Error in Conflicts of Interest Disclosures, JAMA Cardiology, Vol: 2, Pages: 1284-1284, ISSN: 2380-6583
In the Review titled “Diagnostic Accuracy of Computed Tomography–Derived Fractional Flow Reserve: A Systematic Review,”1 published online May 24, 2017, and in print July 1, 2017, there was an omission in the Conflicts of Interest Disclosures. The authors listed potential conflicts of interest on the ICMJE disclosure forms, but due to an administrative error, the disclosures were not included in the article.The published Conflict of Interest Disclosures should have been: “All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Cook reported receiving personal fees from Philips Volcano outside the submitted work. Dr Petraco reported receiving consultancy and speaker fees from Philips Volcano. Dr Nijjer reported receiving speaker fees for teaching from Philips Volcano. Dr Kikuta reported receiving personal fees from Philips Volcano, Boston Scientific, and Boehringer Ingelheim (during the conduct of the study). Dr Shiono reported receiving personal fees and nonfinancial support from Philips Volcano. Dr Mayet reports that Imperial Innovations has a patent for invasive assessment of pressure drop across a coronary stenosis licensed and that he is one of the inventors of the technique. Dr Davies reported receiving grants and personal fees from Philips Volcano (during the conduct of the study), Medtronic, and Recor; and grants from AstraZeneca. Unless stated, all disclosures were outside the submitted work. No other disclosures were reported.”This article was corrected online.
Wijntjens G, Kikuta Y, van de Hoef T, et al., 2017, Hemodynamic changes after percutaneous coronary interventions of stenoses with discordant fractional flow reserve and coronary flow reserve, 29th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B138-B139, ISSN: 0735-1097
Ahmad Y, Demir O, Howard J, et al., 2017, Aspirin is equivalent to dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of 11,781 patients, 29th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B54-B54, ISSN: 0735-1097
de Waard G, Cook C, Petraco R, et al., 2017, Diastolic-systolic velocity ratio to detect coronary stenoses, 29th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B170-B170, ISSN: 0735-1097
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- Citations: 1
van der Hoeven N, de Waard G, Quiros A, et al., 2017, Novel method to assess both the epicardial and microvascular domain using vascular conductance obtained from intracoronary pressure and flow velocity, 29th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B154-B154, ISSN: 0735-1097
Echavarria-Pinto M, van de Hoef TP, Nijjer S, et al., 2017, Influence of the amount of myocardium subtended to a coronary stenosis on the index of microcirculatory resistance. Implications for the invasive assessment of microcirculatory function in ischaemic heart disease, EUROINTERVENTION, Vol: 13, Pages: 944-952, ISSN: 1774-024X
Petraco R, Escaned J, Davies J, 2017, Validation of iFR: Clinical registries, Physiological Assessment of Coronary Stenoses and the Microcirculation, Pages: 225-231, ISBN: 9781447152446
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- Citations: 2
Cook CM, Petraco R, Shun-Shin MJ, et al., 2017, Diagnostic accuracy of computed tomography-derived fractional flow reserve a systematic review, JAMA Cardiology, Vol: 2, Pages: 803-810, ISSN: 2380-6591
Importance Computed tomography–derived fractional flow reserve (FFR-CT) is a novel, noninvasive test for myocardial ischemia. Clinicians using FFR-CT must be able to interpret individual FFR-CT results to determine subsequent patient care.Objective To provide clinicians a means of interpreting individual FFR-CT results with respect to the range of invasive FFRs that this interpretation might likely represent.Evidence Review We performed a systematic review in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic search of MEDLINE (January 1, 2011, to 2016, week 2) and EMBASE (January 1, 2011, to 2016, week 2) was performed for studies assessing the diagnostic accuracy of FFR-CT. Title words used were computed tomography or computed tomographic and fractional flow reserve or FFR. Results were limited to publications in peer-reviewed journals. Duplicate studies and abstracts from scientific meetings were removed. All of the retrieved studies, including references, were reviewed.Findings There were 908 vessels from 536 patients in 5 studies included in the analysis. A total of 365 (68.1%) were male, and the mean (SD) age was 63.2 (9.5) years. The overall per-vessel diagnostic accuracy of FFR-CT was 81.9% (95% CI, 79.4%-84.4%). For vessels with FFR-CT values below 0.60, 0.60 to 0.70, 0.70 to 0.80, 0.80 to 0.90, and above 0.90, diagnostic accuracy of FFR-CT was 86.4% (95% CI, 78.0%-94.0%), 74.7% (95% CI, 71.9%-77.5%), 46.1% (95% CI, 42.9%-49.3%), 87.3% (95% CI, 85.1%-89.5%), and 97.9% (95% CI, 97.9%-98.8%), respectively. The 82% (overall) diagnostic accuracy threshold was met for FFR-CT values lower than 0.63 or above 0.83. More stringent 95% and 98% diagnostic accuracy thresholds were met for FFR-CT values lower than 0.53 or above 0.93 and lower than 0.47 or above 0.99, respectively.Conclusions and Relevance The diagnostic accuracy of FFR-CT varies markedly across the spectrum of disease. This ana
Davies JE, Sen S, Dehbi H-M, et al., 2017, Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 376, Pages: 1824-1834, ISSN: 0028-4793
Cook C, Petraco R, Ahmad Y, et al., 2017, Diagnostic Accuracy of FFR-CT: Implications for Clinical Decision Making, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 10, Pages: S50-S50, ISSN: 1936-8798
Cook CM, Jeremias A, Ahmad Y, et al., 2017, Discordance in Stenosis Classification by Pressure Only Indices of Stenosis Severity is Related to Differences in Coronary Flow Reserve: - The DISCORD Study, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 10, Pages: S27-S27, ISSN: 1936-8798
de Waard GA, Nijjer SS, van Lavieren MA, et al., 2016, Invasive minimal Microvascular Resistance Is a New Index to Assess Microcirculatory Function Independent of Obstructive Coronary Artery Disease, Journal of the American Heart Association, Vol: 5, ISSN: 2047-9980
Background-—Coronary microcirculatory dysfunction portends a poor cardiovascular outcome. Invasive assessment ofmicrocirculatory dysfunction by coronary flow reserve (CFR) and hyperemic microvascular resistance (HMR) is affected bycoronary artery disease (CAD). In this study we propose minimal microvascular resistance (mMR) as a new measure ofmicrocirculatory dysfunction and aim to determine whether mMR is influenced by CAD.Methods and Results-—We obtained 482 simultaneous measurements of intracoronary Doppler flow velocity and pressure. ThemMR is defined as the ratio between distal coronary pressure and flow velocity during the hyperemic wave-free period.Measurements were divided into 2 cohorts. Cohort 1 was a paired analysis involving 81 pairs with a vessel with and without CAD toinvestigate whether HMR, CFR, and mMR are modulated by CAD. CFR was lower, and HMR was higher, in vessels with CAD than invessels without CAD: 2.12 0.79 versus 2.56 0.63 mm Hgcm 1s, P<0.001, and 2.61 1.22 versus 2.31 0.89 mm Hgcm 1s,P=0.04, respectively. mMR was equal in vessels with and without CAD: 1.54 0.77 versus 1.53 0.57 mm Hgcm 1s, P=0.90.Differences for CFR occurred when FFR was 0.60 to 0.80 or ≤0.60 but not when FFR ≥0.80. For HMR, the difference occurred onlywhen FFR ≤0.60. For mMR, no difference was observed in any FFR stratum. Cohort 2 was used for validation and showed significantrelationships for CFR and HMR with FFR: Pearson r=0.488, P<0.001 and 0.159, P=0.03, respectively; mMR had no associationwith FFR: Pearson r=0.055; P=0.32.Conc
Cook C, Ahmad Y, Petraco R, et al., 2016, TCT-9 A per-vessel level systematic review of computed tomography-derived FFR (FFR-CT) diagnostic accuracy studies: Implications for clinical decision-making., J Am Coll Cardiol, Vol: 68, Pages: B4-B4
van der Hoeven N, Quirós A, de Waard G, et al., 2016, TCT-523 Instantaneous Hyperemic Diastolic Velocity Pressure Slope for comprehensive physiological evaluation of epicardial and microvascular status., J Am Coll Cardiol, Vol: 68, Pages: B211-B211
de Waard G, Nijjer S, van Lavieren M, et al., 2016, TCT-524 Invasive minimal Microvascular Resistance (mMR); a new index to assess microcirculatory dysfunction that is not modulated by the presence of angiographic coronary artery disease., J Am Coll Cardiol, Vol: 68, Pages: B211-B212
Cook C, Jeremias A, Ahmad Y, et al., 2016, TCT-513 Discordance In Stenosis Classification by pressure-Only indices of stenosis severity is Related to Differences in coronary flow reserve: The RESOLVING DISCORD study., J Am Coll Cardiol, Vol: 68, Pages: B206-B207, ISSN: 0735-1097
Foin N, Lee R, Bourantas C, et al., 2016, Bioresorbable vascular scaffold radial expansion and conformation compared to a metallic platform: insights from in vitro expansion in a coronary artery lesion model, EUROINTERVENTION, Vol: 12, Pages: 834-844, ISSN: 1774-024X
Cook CM, Petraco R, Ahmad Y, et al., 2016, Systematic review of non- invasive computed tomography-derived FFR (FFR-CT) studies to guide integration of FFR-CT into mainstream clinical practice, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 609-610, ISSN: 0195-668X
Davies JE, Petraco R, 2016, Noninvasive Physiological Assessment of Coronary Stenoses With Computed Tomography: Can Fractional Myocardial Mass Trump Computed Tomographic Fractional Flow Reserve Via Simplification?, JACC: Cardiovascular Interventions, Vol: 9, Pages: 1561-1563, ISSN: 1876-7605
Cook CM, Kousera C, Ahmad Y, et al., 2016, Can computational fluid dynamics (CFD) predictions of FFR really agree with invasive FFR in intermediate stenoses? Lessons from a study using optical coherence tomography (OCT) and invasive measures, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 609-609, ISSN: 0195-668X
Ahmad Y, Cook C, Shun-Shin M, et al., 2016, Resolving the paradox of randomised controlled trials and observational studies comparing multi-vessel angioplasty and culprit only angioplasty at the time of STEMI, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 222, Pages: 1-8, ISSN: 0167-5273
Ng J, Foin N, Ang HY, et al., 2016, Over-expansion capacity and stent design model: an update with contemporary DES platforms, International Journal of Cardiology, Vol: 221, Pages: 171-179, ISSN: 1874-1754
BACKGROUND: Previously, we examined the difference in stent designs across different sizes for six widely used Drug Eluting Stents (DESs). Although stent post-dilatation to larger diameter is commonly done, typically in the setting of long tapering segment or left-main PCI, there is an increasing recognition that information with regard to the different stent model designs has a critical impact on overexpansion results. This study aims to provide an update on stent model designs for contemporary DES platforms as well as test overexpansion results under with oversized post-dilatation. METHODS AND RESULTS: We studied 6 different contemporary commercially available DES platforms: Synergy, Xience Xpedition, Ultimaster, Orsiro, Resolute Onyx and Biomatrix Alpha. We investigated for each platform the difference in stent designs across different sizes and results obtained after post-expansion with larger balloon sizes. The stents were deployed at nominal diameter and subsequently over expanded using increasingly large post dilatation balloon sizes (4.0, 5.0 and 6.0mm at 14ATM). Light microscopy was used to measure the changes in stent geometry and lumen diameter after over-expansion. For each respective DES platform, the MLD observed after overexpansion of the largest stent size available with a 6.0mm balloon was 5.7mm for Synergy, 5.6mm for Xience, 5.2mm for Orsiro, 5.8mm for Ultimaster, 5.5mm for 4mm Onyx (5.9mm for the 5mm XL size) and 5.8mm for BioMatrix Chroma. CONCLUSION: This update presents valuable novel insights that may be helpful for careful selection of stent size for contemporary DES based on model designs. Such information is especially critical in left main bifurcation stenosis treatment where overexpansion to larger oversized diameter may be required to ensure full stent apposition.
van de Hoef TP, Petraco R, van Lavieren MA, et al., 2016, Basal stenosis resistance index derived from simultaneous pressure and flow velocity measurements, EUROINTERVENTION, Vol: 12, Pages: E199-E207, ISSN: 1774-024X
Ahmad Y, Cook C, Petraco R, et al., 2016, Multi-vessel Angioplasty at the Time of STEMI has Equivalent Mortality to a Culprit Only Strategy: Resolving The Paradox of Randomised Controlled Trials and Observational Studies in Multivessel Disease and STEMI, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A68-A69, ISSN: 1355-6037
Ahmad Y, Sen S, Nijjer S, et al., 2016, Thrombus Aspiration does not Reduce Mortality in STEMI Patients: A Meta-Analysis of 20,192 Patients, with Implications for Future Trial Design, Annual Conference of the British Cardiovascular Society (BCS) on Prediction and Prevention, Publisher: BMJ Publishing Group, Pages: A24-A25, ISSN: 1355-6037
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