Browsing by Author "Chao, Howard"
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Item Paclitaxel-Eluting Vs. Bare Metal Stent Implantation in Saphenous Vein Graft Lesions: Very Long-Term Follow-up of the SOS (Stenting of Saphenous Vein Grafts) Trial(2015-01-26) Sosa, Alan; Chao, Howard; Guerra, Andres; Han, Henry; Christopoulos, George; de Lemos, James A.; Obel, Owen; Addo, Tayo; Roesle, Michele; Haagen, Donald; Rangan, Bavana V.; Banerjee, Subhash; Brilakis, Emmanouil S.BACKGROUND: The very long-term (>3 year) outcomes after implantation of drug-eluting as compared with bare metal stents (BMS) in saphenous vein grafts (SVGs) have received limited study. METHODS: In the Stenting Of Saphenous vein grafts (SOS) trial 80 patients were randomized to BMS or paclitaxel-eluting stents (PES). During a median follow-up of 35 months use of PES was associated with better clinical outcomes. We report very long-term outcomes on 62 patients enrolled at the highest enrolling institution. RESULTS: Of the 62 studied patients 31 received a BMS and 31 a PES. Both study groups had similar baseline characteristics. During a median follow-up of 6.9 years the study patients experienced 116 major adverse cardiovascular events (MACE). Compared with patients who received BMS those who received PES had lower incidence of MACE (hazard ratio [HR]=0.56, P=0.04), target lesion revascularization (HR=0.20, P=0.001), target vessel revascularization (HR 0.41, P=0.02), target vessel failure (HR=0.35, P=0.001), and definite or probable stent thrombosis (HR=0.14, P=0.03). There was no significant difference in all-cause mortality (HR=1.77, P=0.15) and myocardial infarction (HR=0.52, P=0.10) between the two groups. CONCLUSION: The early benefit observed with use of PES vs BMS in SVGs persisted during very long-term follow-up.Item Real World Outcomes of Prasugrel and Ticagrelor Versus Clopidogrel in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention(2015-01-26) Chao, Howard; Guerra, Andres; Han, Henry; Sosa, Alan; Christopoulos, Georgios; Christakopoulos, Georgios; Tarar, Muhammad Nauman; Kelly, Kevin; Weideman, Rick; Roesle, Michele; Rangan, Bavana V.; Banerjee, Subhash; Brilakis, Emmanouil S.MENTOR AND COLLABORATORS: Andres Guerra, Henry Han, Alan Sosa, Georgios Christopoulos, Muhammad Nauman Tarar, Kevin Kelly, Rick Weideman, Michele Roesle, Bavana V. Rangan, Subhash Banerjee, Emmanouil S. Brilakis, MD, PhD Department of Internal Medicine- Cardiology, University of Texas Southwestern Medical Center & VA North Texas Healthcare System BACKGROUND: ADP P2Y12 inhibitors are routinely administered after percutaneous coronary intervention (PCI) to prevent stent thrombosis. The newer P2Y12 inhibitors, prasugrel and ticagrelor, reduced the incidence of major adverse cardiac events (MACE) compared with clopidogrel in clinical trials of acute coronary syndrome (ACS) patients, but have received limited study in routine clinical practice. OBJECTIVE: To compare the outcomes of prasugrel and ticagrelor with clopidogrel in real world ACS patients undergoing PCI. METHODS: The medical records of all patients who underwent PCI at our institution between January 2011 and November 2013 were reviewed. The 12- month incidence of MACE (death, myocardial infarction, and repeat coronary revascularization) and bleeding was compared between patients who received a novel P2Y12 inhibitor (prasugrel or ticagrelor) and a random sample of those who received clopidogrel. RESULTS : Two hundred and one patients who underwent PCI for ACS were included: 80 received either prasugrel or ticagrelor and 121 received clopidogrel. Mean age was 63.7 ± 9.3 years and 99% of the patients were men. The two study groups had similar baseline characteristics. The 12-month incidence of MACE in the novel P2Y12 inhibitor subgroup was 23% versus 33% in the clopidogrel subgroup (p = 0.25). Patients receiving prasugrel or ticagrelor had lower incidence of all cause (p < 0.01) and cardiac (p = 0.05) death, and similar incidence of bleeding. CONCLUSION: In a non-selected ACS population use of a novel P2Y12 inhibitor was associated with lower incidence of death and similar incidence of bleeding as compared with clopidogrel.