| RODRIGUEZ ALFREDO E , M.D., Ph.D., FACC., FSCAI | ||||||
| Personal Data | ||||||
| Born: | Córdoba, Argentina | |||||
| Home Address: | Av. Callao 1441- 4 Floor, “B” (1024). Buenos Aires, Argentina | |||||
| Phone: | Private (54 11) 155327-4530 / Office (54 11) 4962-9012 | |||||
| Phone/Fax | Office (54 11) 4964 8721 | |||||
| Spouse: | Marta Maria Biagioni | |||||
| Children: | Alfredo Matías: January 13, 1976 Gastón Alfredo: January 13, 1979 Agustina: October 8, 1981 Tomás Moises: January 19, 1987 Clara María: September 23, 1993 Catalina: May 16, 2006 | |||||
| Education | ||||||
| 1969-1974 | Córdoba National University, School of Medicine. Title obtained: Medical Surgeon. | |||||
| 1984 | Córdoba Catholic University, Degree of Ph. D. with the subject: Coronary Angioplasty and Intracoronary Thrombolysis (Score: Outstanding). | |||||
| 1985 | Argentine Collegium of Hemodynamics. Degree: Specialist on Hemodynamics and Angiography. | |||||
| Training | ||||||
| 1974 | Internship in Internal Medicine, Air Force Hospital, Córdoba, Argentina. | |||||
| 1975 – 1978 | Resident at the Cardiology Department, Hospital Privado Sanatorio Güemes, Favaloro Foundation, Buenos Aires, Argentina. | |||||
| 1979 | Chief of Residents, Cardiology Department, Hospital Privado Sanatorio Guemes, Favaloro Foundation, Buenos Aires, Argentina. | |||||
| 1981 | Internship in the Interventional Cardiology Service, San Francisco Heart Institute, San Francisco, U.S.A. Director: Richard Myler, M.D., F.A.C.C. | |||||
| Hospital Appointments | ||||||
| 1982 – 1985 | Staff Member, Interventional Cardiology Service, Hospital Privado Sanatorio Guemes, Favaloro Foundation, Buenos Aires, Argentina. | |||||
| 1985-1988 | Former Assistant Director, Interventional Cardiology Service, Hospital Privado Sanatorio Güemes, Favaloro Foundation, Buenos Aires, Argentina | |||||
| 1988-1999 | Former Chief, Interventional Cardiology Service, Sanatorio Anchorena, Buenos Aires, Argentina. | |||||
| 1991 | Former Consultant, Interventional Cardiology Service, Cosme Argerich Hospital, Buenos Aires, Argentina. | |||||
| 1992 | Consultant, Interventional Cardiology Service, Spanish Hospital, Mendoza, Argentina | |||||
| 1993=current | Chief, Interventional Cardiology Service, Otamendi Hospital, Buenos Aires, Argentina. | |||||
| 1993 | Consultant, Interventional Cardiology, Spanish Hospital, Bahía Blanca, Argentina | |||||
| 1998 | Chief, Interventional Cardiology Service, Adrogue Medical Institute, Adrogué- Buenos Aires, Argentina | |||||
| 2003 | Chief, Interventional Cardiology Service, Las Lomas Institute, Buenos Aires, Argentina. | |||||
| Teaching and Academic Appointments | ||||||
| 1991 – 1998 | Co-Director in the Teaching Unit assigned to the Sanatorio Anchorena for the Senior Course of Specialist in Cardiology, Buenos Aires University, School of Medicine | |||||
| 1990- | Founder and Current President of Contract Research Organization (CRO) Cardiovascular Research Center (CECI) Buenos Aires Argentina. | |||||
| 2001 | Director Post Graduate Medical School –Senior Course of Specialist in Cardiology, Buenos Aires University School of Medicine | |||||
| 2002 | Director Post Graduate Medical School –Senior Course of Specialist in Cardiology, Buenos Aires University School of Medicine | |||||
| Awards | ||||||
| 1981 | National Academy of Medicine, RAFAEL BULLRICH Award (Bi-Annual, to the best work on Cardiology on the subject: Angiographic and Clinical Relationship in Acute Myocardial Infarction (First Author). | |||||
| 1990 | DR. Luis Sivori Award (Annual, to the best work on Cardiology), Buenos Aires University, School of Medicine on the subject: New View in the Physiopathology of Coronary Obstruction regarding the Angiographic Analysis (First Author). | |||||
| 1993 | ARGENTINE FOUNDATION OF CARDIOLOGY Award (Annual, to the best work on Cardiology), and Banco Mayo Foundation on the subject: Angiographic Correlates after Primary PTCA in Acute Myocardial Infarction (First Author).ARGENTINE SOCIETY OF CARDIOLOGY Award (Annual, to the best work on Cardiology), on the subject: Coronary Stents reduce Restenosis in Lesions with early loss after successful PTCA (First Author). | |||||
| 1994 | ARGENTINE JOURNAL OF CARDIOLOGY: Best Paper Published during 1994. | |||||
| 1995 | ROBERTO VILLAVICENCIO FOUNDATION Award. To the best work about interventional cardiology of the specialist career From the UBA Medicine University. First Award. Subject: Carotid Angioplasty Initial Results | |||||
| 1996 | SOLACI Award. To the best free work presented at the Latinoamerica Society for Interventional Cardiology SOLACI Congress 1997. Subject: Optimal balloon angioplasty vs stent (First Author).Angiographic Follow Up of a Randomized Work. | |||||
| 1997 | NOMINEE ETHICA Award. Best Clinical Investigators – ERASMUS University. Rotterdam, The Netherlands.To the best clinical researcher in the Interventional Cardiology area 1997. | |||||
| 2000 | USCAS Award. For the best work in Venezuela Society of Cardiology.XIX Sudamerican Congress of Cardiology/XXXIII Congreso Venezolano de Cardiología. “Cost Effectiveness Analysis Between Percutaneous Coronary Interventions vs. Coronary Bypass Surgery in Multiple Vessels Disease: Long Term Follow Up Results of the Randomized Study (ERACI II)”, (First Author) | |||||
| 2001 | National Academy of Medicine GERONIMO H. ALVAREZ Award. Three Annual Best Award.National Academy of Medicine. Subject Treatment of Coronary Artery Stenosis. Long Term Follow up Results of ERACI II Study. XXVIII Congress of Cardiology in Argentina . For the best abstract presented. ALEJANDRO SPINETTA Award. | |||||
| 2005 2007 2015 2018 | European Society of Cardiology, European Congress of cardiology, best abstract presentation, Stockholm, Sweden, October 2005.Best scientific work (o best scientific publication, habria que ver). Latinarmerican Congress of Interventional Cardiology (SOLACI 2007). Latinamerican Society of Interventional Cardiology (SOLACI).Best scientific work (o publication). Latinamerican Congress of Interventional Cardiology (SOLACI 2015). Latinamerican Society of Interventional Cardiology (SOLACI)Declared “Outstanding personality of the autonomous city of Buenos Aires in the field of Medical Sciences” by the Buenos Aires House of Representatives | |||||
| Medical Society and Journals Memberships | ||||||
| 1979 | Member, Argentine Society of Cardiology. | |||||
| 1971- 1988 | Member, Editorial Board, Corde Journal, Favaloro Foundation | |||||
| 1982 – 1987 | Executive Member, Argentine Society of Cardiology | |||||
| 1983 | Honorary Member, Bolivian Society of Cardiology | |||||
| 1985 | Member participant in the foundation of the Argentine Collegium of Hemodynamics | |||||
| 1988 | Former Director, Council of Hemodynamics, Argentine Society of Cardiology | |||||
| 1989 – 1991 | Executive Member of the Scientific Committee, Argentine Collegium of Hemodynamics | |||||
| 1991 | Consultant Editor, Iberoamerican Cardiology Journal | |||||
| 1992 | Delegate, Hemodynamics Committee, Union of Cardiology Societies of South America. Member, Editorial Board of the Interventional Cardiology Journal, Panama. | |||||
| 1993 | Associate Director, Iberoamerican Journal of Hemodynamics, Angiography and Therapeutic Catheterization (SOLACI Official Journal). | |||||
| 1995 | Fellow of the American College of Cardiology (February 1995).President Organization Committee Argentine Interventional Cardiology Meeting, Mar del Plata, Argentina. | |||||
| 1997 | President Scientific Committee Latinoamerica Society of Interventional Cardiology. | |||||
| 1998 | Full Member, Andreas Gruentzig SocietyMember Editorial Board Argentine Journal of CardiologyMember Executive Committee – Clinical Latinoamerican Council of Interventional Cardiology (CLINIC). | |||||
| 2002 | Fellow Society for Cardiac Angiography and Intervention. (March 2002). | |||||
| 2003 | Advisor Agreement – CACI ANMAT | |||||
| 2005 | Editorial Board EuroIntervention Journal | |||||
| 2007 | Editorial Board JACC Cardiovascular Interventions Associate Editor. Case Reports in Cardiology. Hindawi Editorial. Associate Editor. International Journal of Cardiology. Hindawi Editorial. | |||||
| Research Protocols | ||||||
| 1979 | Principal Investigator. Chronic Asymptomatic Infarction: angiographic correlates. Published in Argentine J of Cardiol 1979 | |||||
| 1980 | Principal Investigator. Thrombolysis in Acute Myocardial Infarction. Abstract presented in the X South American Congress of Cardiology, Buenos Aires, Argentina | |||||
| 1984 | Principal Investigator. Systemic use of Urokinase in AMI. Randomized Study 1984. Abstract presented in the Congress of Cardiology, Washington DC, U.S.A. in 1986 | |||||
| 1985 | Principal Investigator. Clinical and Angiographical Correlation in the Reduction of the Degree of Obstruction after Thrombolytic Therapy in Acute Myocardial Infarction (Am J Cardiol 1986). | |||||
| 1988 | Director of the Argentine Randomized Study: Angioplasty vs. Surgery in multiple vessel Disease, coordinated by the Massachusetts General Hospital and the Medicine School of the Harvard University, U.S.A. (J Am Coll. Cardiol 1993). | |||||
| 1989 | Director Serial angiographic study 24 hours and 6 months after PTCA (in collaboration with Massachusetts General Hospital , Harvard University, Boston, U.S.A.) Am J. Cardiol 1993 | |||||
| 1991 | Director of the Study on Stent for Prevention of Restenosis in high risk groups, detected by angiography in 24 hs. (in collaboration with Dr. Gary S. Roubin, University of Birmingham, Alabama, U.S.A. | |||||
| 1994 | Director, Angiography Committee, International Study ECLA 2RAPT. (In collaboration with Franz Van der Warf, Leuvan University, Belgium) published in Circulation in February 1994. | |||||
| 1996 | Principal Investigator. Antisense Randomized Trial to prevent restenosis in collaboration with Thomas Jefferson University, Philadelphia, U.S.A.) | |||||
| 1997 | Director, Optimal Angioplasty and provisional stenting vs universal stenting (OCBAS) Multicenter, multinational randomized study. JACC , November 15, 1998.Director, GRAMI Trial. Stents (GR II) vs PTCA in Acute Myocardial Infarction Multicenter, multinational randomized study. Am J Cardiol 1998;81.Director, ERACI Phase II. Multicenter, multinational randomized study comparing Stents (GR II) vs CABG in multivessel coronary artery disease | |||||
| 1998 | Principal Investigator SLAM trial. Multicenter, Multinational Study Stent vs Balloon Angioplasty in long lesions. Sponsored by Johnson & Johnson. Co-Chairmans Richard Kuntz and Jeffrey Popma. | |||||
| 2000 | Principal Investigator “SENIOR PAMI”. A Prospective Randomized Trial of Primary Angioplasty vs. Thrombolytic Therapy for Acute Myocardial Infarction in the Elderly.William Beaumont Hospital. USAPrincipal Investigator “ACE Trial” Abciximab and Carbostent Evaluation in Acute Myocardial Infarction. Careggi Hospital, Florence, ITALY.Co Investigators “OAT Trial” Occluded Artery Trial. USAPrincipal Investigator. “Biodivysio South American Small Vessels Randomized Study”. LASMAL trial. | |||||
| 2003 | Principal Investigator. Oral Rapamycin in Patients Undergoing Coronary Stent Therapy. The ORAR Study (Oral Rapamycin in Argentina). | |||||
| 2004 | Principal Investigator. Oral Rapamycin Following Coronary Bare Stent Implantation to Prevent Restenosis: The Prospective, Randomized ORAR II (Oral Rapamycin in Argentina ) Study.Principal Investigator. Stem Cells therapy following primary PCI in Acute Myocardial Infarction (STAR AMI Trial) Stem Cells in Argentina. Investigator. TAXUS OLYMPIA Registry. | |||||
| 2005 | Principal Investigator.Revascularization Strategies of Coronary Multiple Vessel Disease In Drug Eluting Stent Era. ERACI III Registry.Investigator. AngioJet Rheolytic Thrombectomy Before Direct Infarct Artery Stenting in Patients Undergoing Primary PCI for Acute Myocardial Infarction [JETSTENT Study]Investigator. HORIZONS trial. | |||||
| 2006 | Investigator. Future Revascularization evaluation in patients with diabetes mellitus: Optimal Management of Multivessel disease. The Freedom Trial.Principal Investigator. Cost Effectiveness Randomized comparison between Oral Rapamycin following Bare Stent Implantation vs. Drug Eluting stent. ORAR III trial.Principal Investigator. MULTISTRATEGY.Principal Investigator. New Coating Stent Design for Patients with high risk Coronary Lesions for Thrombotic events. The CAMOUFLAGE Registry.Principal Investigator. FREEDOM trial. Clinical Investigator and country leader. | |||||
| 2007 | Principal Investigator. Randomized, multicenter comparision between a palitaxel eluting stent vs a bare metal stent. EUCATAX trial. | |||||
| 2008 | Investigator. Randomized Comparison between Cypher versus Endeavor Eluting Stents to Evaluate Stent Thrombosis. PROTECT trial. | |||||
| 2008 | Investigator. Multicenter Randomized Clinical Trial to Evaluate the Efficacy of Intensive Apidra/ Lantus Therapy vs Sliding Scale Insulin on Subjects with Anterior STEMI. INTENSIVE trial. | |||||
| 2013 | Principal Investigator. Multinational and Multicenter registry ERACI IV. | |||||
| 2016 | Principal Investigator. Multinational and Multicenter registry WALTZ. | |||||
| 2017 | Clinical Investigator. MASTER DAPT study. | |||||
| 2020 | Principal Investigator and member of the Steering Committee. Multicenter and randomized study ORCA trial. | |||||
| Meetings participation. | ||||||
| 1982 | August | Guest Faculty – Visiting Professor, International Meeting: Coronary heart disease, University of Chile, Santiago, Chile | ||||
| 1983 | September | Guest Speaker – Visiting Professor, V Bolivian Congress of Cardiology, La Paz, Bolivia.Honorarium Visitor of Bolivia, title given by the Ministry of Health of BoliviaGuest Faculty, VIII Latinamerican Meeting on Hemostasia and Thrombolysis, Montevideo, Uruguay. | ||||
| 1984 | October | Guest Faculty – Visiting Professor, Course on Therapeutic News on Cardiology, Chilean Medical Society, Santiago, Chile | ||||
| 1987 | October | Guest Faculty – Visiting Professor, VII Bolivian Congress of Cardiology, Bolivian Society of Cardiology, Cochabamba, Bolivia | ||||
| 1988 | September | Guest Faculty – Visiting Professor, III Paraguayan Congress of Cardiology, Asunción, Paraguay.Honorarium Visitor of Paraguay, title given by the Ministry of Health of Paraguay | ||||
| 1989 | November | Guest Faculty – Visiting Professor, International Meeting on Interventional Cardiology, Luis Vernaza Hospital, Guayaquil, Ecuador | ||||
| 1991 | June | Guest Faculty – Visiting Professor, IV International Congress of Cardiology, Panama Society of Cardiology, Panamá. | ||||
| September | Guest Faculty – Visiting Professor, IV International Congress of Cardiology, Panama Society of Cardiology, Panamá. | |||||
| 1992 | February | Guest Faculty, 50th Annual Meeting of Cardiology, San Pablo, Brazil | ||||
| November | Guest Faculty, 50th Annual Meeting of Cardiology, San Pablo, Brazil | |||||
| 1993 | September | Guest Faculty, IV PTCA Meeting, University of Alabama, Birmingham, USA | ||||
| Guest Faculty – Visiting Professor, Paraguayan Congress of Cardiology, Asunción, Paraguay | ||||||
| 1994 | May | Guest Faculty – Visiting Professor, II Sessions on Cardiology and Cardiovascular Surgery, Deutsch Clinic, Catholic University, Santiago, Chile. | ||||
| June | Guest Faculty, Interamerican Congress, Miami Vascular Institute, Miami, USA. | |||||
| August | Guest Faculty – Visiting Professor, Meeting on Interventional Cardiology, Heart National Institute. Lima, Perú | |||||
| September | Guest Faculty, V PTCA Meeting, University of Alabama, Birmingham, USA | |||||
| October | Guest Faculty, Course on Interventional Cardiology, Miami Heart Institute, Orlando, USA | |||||
| Guest Faculty, Visiting Professor, Brazilian Congress of Cardiology, Porto Alegre, Brazil. | ||||||
| 1995 | June | Guest Faculty , Centro Cardiovascular, Santiago Chile | ||||
| July | Guest Faculty: I Congreso de la Sociedad Latinoamericana de Cardiología Intervencionista. San Pablo – Brasil | |||||
| August | Guest Faculty: XVIII Congress of the European Society Cardiology. Amsterdam | |||||
| September | Guest Faculty: Primer Curso Internacional de Intervencionismo por Imágenes. Hospital Guillermo Almenara. Lima – Peru | |||||
| October | Guest Faculty: Taller de Controversia en Cardiología. Clinica Alemana. Santiago Chile. Chile | |||||
| November | Guest Faculty XI Congreso Boliviano de Cardiología. La Paz – Bolivia | |||||
| Guest Faculty: 68 th Scientific Sessions- American Heart Association, Anaheim, California, USA | ||||||
| December | Guest Faculty XV Congreso Interamericano de Cardiología. Santiago – Chile | |||||
| 1996 | January | Guest Faculty Interventional Coronary Stenting. Miami Heart Institute. Miami Beach – Florida | ||||
| May | Guest Faculty: Complex Coronary Angioplasty and new techniques in international cardiology . Clinique Pasteur – Toulouse – France | |||||
| August | Guest Faculty: Satellite Symposium European Society of Cardiology – Birminghan – United Kingdom | |||||
| November | Guest Faculty: 68th Scientific Sessions American Heart Association – New Orleans, Louisiana | |||||
| December | Guest Faculty: XXXIII Congreso de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular, Valdivia, Chile | |||||
| 1997 | March | Guest Faculty: 46th Annual Scientific Session, Anaheim, California, USA | ||||
| April | Guest Faculty XI Practical Course in Interventional Cardiology – Madrid, Spain | |||||
| May June | Guest Faculty: The Endovascular Therapy Course in France – Paris , FranceGuest Faculty. President of Scientific Committee of the Latinamerican Congress of Interventional Cardiology (SOLACI). | |||||
| August | Guest Faculty: XIXth Congress of the European Society of Cardiology Stockholm – Sweden | |||||
| September | Guest Faculty: Washington Convention Center, Transcatheter Cardiovascular Therapeutics – IX Washington DC | |||||
| November | Guest Faculty: 70th Scientific Sessions, American Heart Association. Orlando, Florida, USA | |||||
| December | Guest Faculty: 4th Thoraxcenter Course on Coronary Stenting Rotterdam, Holanda | |||||
| 1998 | January | Guest Faculty: International Andreas Gruentzig Society Meeting. Punta del Este, Uruguay | ||||
| February | Guest Faculty: 10th Annual Advances in Diagnostic and Therapeutic Cardiac Cathterization. Orlando, Florida, USA | |||||
| Guest Faculty: Whistler Conference. Vancouver, Canada | ||||||
| March | Guest Faculty: Kamakura Live Conference. Tokio, Japan | |||||
| Guest Speaker: 47th Annual Scientific Seccion, American College of Cardiology. Atlanta – USA | ||||||
| National Guest Speaker. Actualization Course: Cardiology 98. Cardiology Society from Tucumán. Tucumán, Argentina | ||||||
| April | Guest Speaker: Joint Symposium of the Interventional Cardiology Societies from the Americas, Europe and Asia. Rio de Janeiro, Brasil | |||||
| Guest Speaker: World Congress of Cardiology. Rio de Janeiro, Brasil | ||||||
| May | Guest Faculty: Endovascular Therapy Course Coronary and Peripheral.Toulouse, France | |||||
| June | Guest Faculty: “Current Medical and Interventional Therapy in Acute Coronary Syndromes”. Mount Sinai Medical Center – New York, USA | |||||
| National Guest Speaker: – Continuous Medical Education- Annual Course of Cardiology-IV Coronary Arteriosclerosis. Org. Harvard Medical International. Buenos Aires, Argentina | ||||||
| National Guest Speaker: “Symposium”. Italian Hospital from Rosario. Rosario, Argentina. | ||||||
| National Guest Speaker. “VII National Congress of Cardiology”. Argentina Federation of Cardiology. Rosario, Argentina. | ||||||
| July | Guest Speaker: Madrid Interventional Cardiology (MIC1998) Madrid , España | |||||
| August | Guest Speaker: II Jornada de la Sociedad Latinoamericana de Cardiología Intervencionista (SOLACI 98). Montevideo, Uruguay | |||||
| Guest Faculty: The Annual Convention of the European Society of Cardiology. Vienna, Austria | ||||||
| September | Honor Guest Speaker. XXXI Venezolan Congress of Cardiology. Municipio Vargas, Venezuela. | |||||
| International Panelist. VIII. Trasandinas Journals of Cardiology and Cardiovascular Cirugy. Santiago, Chile. | ||||||
| October | Faculty Member: Transcatheter Cardiovascular Therapeutics – Tenth Anniversary. Washington, USA | |||||
| Director Symposium de Hemodinamia XXV Congreso Argentino de Cardiología, Sociedad Argentina de Cardiología. Buenos Aires, Argentina | ||||||
| November | 71st Scientific Sessions, American Heart Association. Dallas, USA | |||||
| December | Chairman: South table: Interventional Symposium Favaloro Foundation. Buenos Aires, Argentina | |||||
| Guest Speaker: National Congress Argentino. Council and Interventional Cardiology. Buenos Aires, Argentina | ||||||
| Guest Faculty. International Andreas Gruentzig Society (IAGS) Meeting. Punta del Este, Uruguay | ||||||
| 1999 | January | Chairman: The Dawn of a New Era in the Treatment of Acute Myocardial Infarction. Florence, Italy | ||||
| February | Guest Faculty: Whistler Conference. Vancouver, Canadá | |||||
| Guest Faculty: 47th Annual Meeting American College of Cardiology.New Orleans, USA | ||||||
| March | Guest Faculty: VII Interventional Cardiology Course of the National Institute of Cardiology “Ignacio Chavez”. México, México | |||||
| August | Guest Speaker: III Congress of Interventional Cardiology Latinoamerican Society (SOLACI 99). Santiago, Chile | |||||
| September | Guest Faculty: Transcatheter Cardiovascular Therapeutics. Washington DC, USA | |||||
| December | National Guest Speaker: Sociedad Argentina de Cardiologia (SAC) | |||||
| 2000 | February | Guest Faculty: The Whistler Course 2000.Vancouver. Canada | ||||
| March | Guest Faculty: American College of Cardiology (ACCIS 2000). Anaheim, California. USA | |||||
| May | Guest Faculty: The Paris Course on Revascularization. Paris. France | |||||
| Guest Faculty: 6th Biennial International Andreas Gruentzig Society (IAGS) Meeting. Crete, Greece. | ||||||
| July | Guest Faculty. VI Congress of Interventional Cardiology Latinoamerican Society (SOLACI 2000). Caracas. Venezuela. | |||||
| August | Guest Faculty. XXII Congress of European Society of Cardiology.Amsterdan. The Netherland. Holanda | |||||
| September | Organizing Committee: The Interventional Cardiology Symposium in the Argentine Congress of Cardiology. Buenos Aires. Argentina | |||||
| Director: Interventional Cardiology Course. CECI 2000. Otamendi Hospital. Buenos Aires Argentina | ||||||
| October | Guest Faculty: TCT. Transcatheter Cardiovascular Therapeutics.Washington. USA. | |||||
| November | Guest Speaker: GISE. National Congress of Italian Invasive Cardiology. Palermo. Italia | |||||
| 2001 | January | Guest Faculty: 10th Singapore LIVE (Live Interventions in Vascular Endotherapy. Singapore. | ||||
| February | Guest Faculty: 50 Anniversary Mexico Institute of Cardiology. Mexico, Mexico | |||||
| Guest Faculty : 10 th Annual Interventional Cardiology Whistler Course 2001New Practices In Interventional Cardiology – Vancouver, Canada. | ||||||
| March | Guest Faculty: American College of Cardiology, 50th Annual Scientific Session. Orlando. USA | |||||
| April | Guest Speaker. XX National Congress of Cardiology – FAC 2001. Catheterization Symposium Therapy. Córdoba. Argentina | |||||
| May | Guest Faculty. EURO – PCR 2001. The Paris Course on Revascularization. Paris. France | |||||
| June | Guest Speaker. I International Symposium of Ischemic Cardiopathy from the Cardiology Institute of Corrientes. Corrientes, Argentina | |||||
| Contribution Faculty and CathSap II American College of Cardiology. USA | ||||||
| July | Guest Speaker. VII Congress of the Latinoamerican Society of Interventional Cardiology. Mexico, Mexico | |||||
| September | Guest Faculty. TCT 2001, Transcatheter Cardiovascular Therapeutics. Washington DC, USA. | |||||
| Director: Interventional Cardiology Course. CECI 2001. Otamendi Hospital Buenos Aires, Argentina | ||||||
| Organizing Committee: The Interventional Cardiology Symposium in the Argentine Congress of Cardiology. Buenos Aires. Argentina | ||||||
| October | Guest Faculty. GISE Meeting. Cuomo, Italy | |||||
| December | President. National Congress of Cardiology. Argentine Society of Interventional Cardiology. Bariloche, Argentina. | |||||
| December | Guest Faculty. Chilean Congress of Cardiology. Pucón, Chile | |||||
| 2002 | February | Guest Faculty. IAGS International Andreas Gruentzig Society Meeting. St. Lucia, Caribbean | ||||
| March | Guest Faculty. ACC Cardiology Meeting Atlanta. USA | |||||
| May | Guest Faculty. National Symposium. Society for Cardiac Angiography and Interventions (SCA & I ). Seattle, Washington. | |||||
| Guest Faculty. EURO – PCR 2001. The Paris Course on Revascularization. Paris. France | ||||||
| Guest Faculty. Society for Cardiac Angiography Meeting. Seattle. USA | ||||||
| Guest Faculty. Euro PCR 2002. Paris France | ||||||
| National Guest Speaker. Course of the Argentininan Society of Cardiology (SAC). “From the problem to solution”Buenos Aires, Argentina | ||||||
| National Guest Speaker. Simposio Cardiología 2002. “The Italo Argentinian focus”(UBA) Buenos Aires, Argentina | ||||||
| June | Guest Faculty. Miyazaki, Japan | |||||
| National Guest Speaker. “The Health in Argentina” ( SAC ). Buenos Aires, Argentina | ||||||
| July | Guest Faculty. VIII Congress of the Latin American Society of Interventional Cardiology (SOLACI). Lima, Peru | |||||
| August | Guest Faculty. Interventional Cardiology Symposium Federation Argentine of Cardiology (FAC 2002). Mar del Plata, Argentina | |||||
| September | Guest Faculty. TCT 2002, Transcatheter Cardiovascular Therapeutics. Washington DC, USA | |||||
| October | Guest Faculty. XXIX Argentine Congress of Cardiology. Argentine Society of Interventional Cardiology (SAC-CACI). Buenos Aires, Argentina | |||||
| . President Interventional Cardiology Symposium in the Argentine Congress of cardiology (CECI 2002). Otamendi Hospital. Buenos Aires, Argentina | ||||||
| November | Guest Faculty. XII Interventional Cardiology Congress (CACI 2002). Córdoba, Argentina | |||||
| Guest Faculty. Interventional Cardiology Congress Society of Interventional Cardiology of Mexico ( SOCIME 2002 ). Monterrey, Mexico. | ||||||
| Guest Faculty. International Andreas Gruentzig Society (IAGS) Meeting. St. Lucía (Caribbean). | ||||||
| 2003 | March | Guest Faculty: 2ª Interventional Cardiology Meeting. Isla Múcura – Colombia | ||||
| July | Guest Faculty: IX Congress of SOLACI / XXV Congress of SBHCI. Sao Paulo, Brasil | |||||
| August | Guest Faculty: XXII National Congress of Cardiology (FAC). Buenos Aires, Argentina | |||||
| Guest Faculty: Revascularization in multivessel dissease in Argentina. (SAC) Rosario, Argentina | ||||||
| September | Guest Faculty. TCT 2003, Transcatheter Cardiovascular Therapeutics. Washington DC, USA | |||||
| October | President Interventional Cardiology Symposium in the Argentine Congress of cardiology (CECI 2003). Otamendi Hospital. Buenos Aires, Argentina. | |||||
| October | Guest Faculty: XXX Argentine Congress of Cardiology (SAC) Buenos Aires, Argentina | |||||
| Guest Faculty: Endovascular and Myocardial Therapies (TEAM) – Madrid España | ||||||
| Guest Faculty: Pre-Congress Course, Actual and future cardiology 2003 –Sanatorio Guemes. Buenos Aires, Argentina | ||||||
| November | Guest Faculty: XIII CACI Congress. Mar del Plata, Argentina | |||||
| Guest Faculty AHA 2003 | ||||||
| December | Guest Faculty: XL Chilean Congress od Cardiology and Cardiovascular surgery, Viña del Mar – Chile | |||||
| 2004 | January | Guest Faculty; 8th Biennial Meeting of the International Andreas Gruentzing Society. Lanai Hawaii | ||||
| March | Guest Faculty; 53 rd Anual Scientific Session. (ACC). New Orleans USA | |||||
| Guest Faculty. TEP course “ Endovascular Percutaneous Therapies” Buenos Aires Argentina | ||||||
| April | Guest Faculty. XI Intervencionist Cardiology Simposium. La Habana , Cuba | |||||
| May | Guest Faculty. EURO – PCR 2004. The Paris Course on Revascularization. Paris. France. | |||||
| Guest Faculty. XXIII National Congress of Cardiology. FAC. Tucuman, Argentina | ||||||
| June | Guest Faculty: Simposium “Myocardial Revascularization in High Risk Patients”, Rosario, Argentina | |||||
| August | Guest Faculty. Congress of European Society of Cardiology. Munich, Alemania | |||||
| Guest Faculty; X Congress of the Latin American Society of Interventional Cardiology (SOLACI) , Buenos Aires, Argentina | ||||||
| September | Guest Faculty. TCT 2004, Transcatheter Cardiovascular Therapeutics. Washington DC, USA | |||||
| October | President Interventional Cardiology Symposium in the Argentine Congress of cardiology (CECI 2004). Otamendi Hospital. Buenos Aires, Argentina | |||||
| Guest Faculty, XXXI Argentine Congress of Cardiology (SAC). Buenos Aires, Argentina | ||||||
| November | Guest Faculty. Congreso (SOCIME) Ciudad de Mexico, Mexico | |||||
| Guest Faculty. International Andreas Gruentzig Society (IAGS) Meeting. Lanai, Hawaii | ||||||
| 2005 | March | Guest Faculty; (ACC). USA | ||||
| Guest Faculty, Cardiovascular Revascularization Therapies (CRT), Washington DC, USA | ||||||
| April | Guest Faculty, SOLACI Mexico | |||||
| May | EURO – PCR 2005. The Paris Course on Revascularization. Paris. France. | |||||
| June | Canada | |||||
| September | Stockholm | |||||
| October | Chile | |||||
| 2006 | March | Guest Faculty; Annual Scientific Session. (ACC). Atlanta- USA | ||||
| April | Guest Faculty, Cardiovascular Revascularization Therapies (CRT) Washington DC, USA | |||||
| Guest Faculty, TCT 2006, Transcatheter Cardiovascular Therapeutics, Asia Pacific, Seoul Korea | ||||||
| Guest Speaker II Reunión sobre prevención y tratamiento de las complicaciones en intervenciones coronario percutáneo, Barcelona, Spain. | ||||||
| June | Guest Speaker, 15th Interventional Cardiology Symposium at the Center Theatre in old Montreal.- | |||||
| November | President Interventional Cardiology Symposium in the Argentine Congress of cardiology (CACI – CECI) Pcia. De San Luis.- | |||||
| Guest Faculty. International Andreas Gruentzig Society (IAGS) Meeting. Canouan (Caribbean). | ||||||
| 2007 | February | Guest Speaker, 5TH Annual Miami International Revascularization Summit (MIRS) | ||||
| March | Guest Faculty, Cardiovascular Revascularization Therapies (CRT), Washington DC, USA | |||||
| Guest Faculty; Annual Scientific Session. (ACC), New Orleans, Louisiana, USA | ||||||
| April | Guest Speaker, TEP 2007, Terapeutica Endovascular Percutanea, Buenos Aires, Argentina | |||||
| September | Guest Faculty. Congress of European Society of Cardiology, ESC. Vienna, Austria. | |||||
| Guest Faculty. International Andreas Gruentzig Society Meeting (IAGS). Zurich, Switzerland. | ||||||
| Guest Faculty. International Andreas Gruentzig Society (IAGS) Meeting. Zurich, Switzerland. | ||||||
| 2008 | February | Guest Speaker, III Reunión sobre prevención y tratamiento de las complicaciones en intervencionismo coronario percutáneo. Barcelona, Spain.Guest Faculty, Cardiovascular Revascularization Therapies (CRT). Washington, DC. USA.Guest Speaker Cardiovascular Congress 2008. Miami Beach, Florida. | ||||
| May | Guest Speaker, World Congress of Cardiology. Buenos Aires, Argentina. Guest Speaker, PCR. Barcelona, Spain. | |||||
| July | Guest Speaker, 14th World Congress on Heart Disease, International Academy of Cardiology. Annual Scientific Sessions 2008. Toronto, ON, Canada. | |||||
| October | Guest Speaker, Transcatheter Cardiovascular Therapeutics (TCT) 2008. Washington, DC. USA. | |||||
| 2009 | ||||||
| February | Guest Speaker, Cardiovascular Congress 2009. Miami Beach, Florida.Guest Faculty, Annual Scientific Session American College of Cardiology (AAC) 2009. Orlando, Florida. | |||||
| March | Guest Speaker, China Interventional Therapeutics (CIT) 2009. Beijing, China. | |||||
| September | Guest Speaker, Transcatheter Cardiovascular Thearpeutics (TCT). The Moscone Center, San Francisco, USA. | |||||
| November | Guest Speaker, American Heart Association (AHA). Orlando, Florida. USA. | |||||
| 2010 | January March | Guest Faculty. 10th Biennial Meeting of the International Andreas Gruentzig Society. Cape Town and Sabi Sabi, South Africa. Guest Speaker, China Interventional Therapeutics (CIT) 2010. Beijing, China. | ||||
| May | Chairperson, Euro PCR 2010. Paris, France. | |||||
| June August | Guest Faculty, Guest Speaker, 2010 Live Symposium of Complex Coronary & Vascular Cases. New York, USA. Guest Faculty. President of the Scientific Committee of the Latinamerican Congress of Interventional Cardiology (SOLACI). | |||||
| 2011 | March | Guest Faculty. China Interventional Therapeutics (CIT). Beijing, China. | ||||
| May | Guest Faculty. Congress of the European Association of Percutaneous | |||||
| June | Cardiovascular Interventions (PCR). Paris, France. Guest Faculty, Guest Speaker. CCC Live Symposium of Complex Coronary & Vascular Cases. New York, USA. | |||||
| November | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). San Francisco, California. | |||||
| 2012 | March | Guest Faculty. China Interventional Therapeutics (CIT). Beijing, China | ||||
| May | Guest Faculty. Congress of the European Association of Percutaneous | |||||
| June | Cardiovascular Interventions (PCR). Paris, France. Guest Faculty. Live Symposium of Complex Coronary & Vascular Cases. New York, USA. | |||||
| October | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). Miami, Florida.Guest Faculty. 11th Biennial Meeting of the International Andreas Gruentzig Society (IAGS). Costa Rica. | |||||
| 2013 | March June | Guest Faculty. China Interventional Therapeutics (CIT). Beijing, ChinaGuest Faculty. Live Symposium of Complex Coronary, Valvular and Vascular Cases. New York, USA. | ||||
| October/November | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). San Francisco, California | |||||
| 2014 | March June | Guest Faculty. China Interventional Therapeutics (CIT). Beijing, China.Guest Faculty. Live Symposium of Complex Coronary Valvular, and Vascular Cases. New York, USA. | ||||
| September | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). Washington, DC. | |||||
| November/December | Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China. Guest Faculty. 12th Biennial Meeting of the International Andreas Gruentzig Society (IAGS). Rio de Janeiro, Brazil. | |||||
| 2015 | March June | Guest Faculty. China Interventional Therapeutics (CIT). Beijing, China.Guest Faculty. Live Symposium of Complex Coronary Valvular, and Vascular Cases. New York, USA. | ||||
| October | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). San Francisco, California | |||||
| November/December | Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China. | |||||
| 2016 | January March/April | Guest Faculty. 13th Biennial Meeting of the International Andreas Gruentzig Society (IAGS). Queenstown, New ZealandGuest Faculty. China Interventional Therapeutics (CIT). Beijing, China | ||||
| June | Guest Faculty. Live Symposium of Complex Coronary Valvular, and Vascular Cases. New York, USA. Guest Faculty. Annual Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit (C3). Orlando, Florida. | |||||
| October | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). Washington, DC. | |||||
| November/December | Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China. | |||||
| 2017 | March/April | Guest Faculty. China Interventional Therapeutics (CIT). Beijing, China. | ||||
| June | Guest Faculty. Annual Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit (C3). Orlando, Florida. | |||||
| September October/November | Guest Faculty. 40th Anniversary of PTCA. International Andreas Gruentzig Society Meeting. Zurich, Switzerland. Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). Denver, Colorado | |||||
| November/December | Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China | |||||
| 2018 | March | Guest Faculty. China Interventional Therapeutics (CIT). Jiangsu, China. | ||||
| June | Guest Faculty. Annual Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit (C3). Orlando, Florida. | |||||
| September | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). San Diego, California | |||||
| November/December | Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China. | |||||
| 2019 | February March/April | Guest Faculty. 15th Biennial International Andreas Gruentzig Society. Puerto Natales, Chile. Guest Faculty. China Interventional Therapeutics (CIT). Beijing, China. | ||||
| May | Guest Faculty. European Association of Percutaneous Cardiovascular Interventions (PCR). Paris, France. | |||||
| June | Guest Faculty. Annual Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit (C3). Orlando, Florida. | |||||
| September | Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). San Francisco, California | |||||
| 2020 | November/December August September November | Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China. Guest Faculty. President of Scientific Committee of Latinamerican Congress of Interventional Cardiology (SOLACI). Guest Faculty. Transcatheter Cardiovascular Therapeutics (TCT). San Francisco, California.Guest Faculty. Left Main & Coronary Bifurcation Summit (CBS). Nanjing, China. Sociedad Argentina de Cardiologia consejo de hemodinamia y cardiología Intervencionista, docente en curdo virtual 2020 | ||||
| Published Books | ||||||
| 1985 | Rodriguez Alfredo E , De La Fuente L M: Therapeutics by catheterization in ischemic cardiopathy (Transluminal Angioplasty – Coronary Thrombolysis). Editors: Intermédica, Buenos Aires, Argentina. | |||||
| 1988 | Rodriguez Alfredo E : Coronary Transluminal Angioplasty. Editors: Sinopsis, Buenos Aires, Argentina. | |||||
| 1989 | Rodriguez Alfredo E , Pérez Baliño N: Up-to-date tendencies in Cardiology Editors: Intermédica, Buenos Aires, Argentina | |||||
| 2015 | John Ambrose and Rodriguez Alfredo E , Editors. Controversies in Cardiology. Editorial Springer Verlag, Great Britain, (Editor-autor) | |||||
| Collaborations (Books) | ||||||
| 1980 | Liotta D: Cardiac Surgery Technics. Rodriguez Alfredo E ; Co-author, chapters 4 and 5. Editors: Intermédica, Buenos Aires, Argentina | |||||
| 1981 | Pichel R, Patritti J P, De la Fuente L M: Ventricular Function in Ischemic Cardiopathy. Rodriguez Alfredo E , author in one chapter. Editors: Intermédica, Buenos Aires, Argentina. | |||||
| 1985 | Kaplan M, Feldestein C: Clinical Cardiology. Rodriguez Alfredo E , author of the chapter: Coronary Thrombolysis. Editors: Panamericana, Buenos Aires, Argentina | |||||
| 1993 | Bertolasi C, Ramos A: IV Up-to-Date Cardiology. Rodriguez Alfredo E , Santaera O, Micelli M, authors of the chapter: Coronary Restenosis. Editors: Intermédica, Buenos Aires, Argentina. | |||||
| 1994 | Gary S. Roubin, Larry Dean. Rodriguez Alfredo E , author in one chapter – University of Alabama at Birmingham. Interventional Cardiology. Edited by University of Alabama | |||||
| 1995 | Gary S. Roubin, Larry Dean. Rodriguez Alfredo E , author in one chapter – University of Alabama at Birmingham. Interventional Cardiology. Edited by University of Alabama | |||||
| 1996 | Interventional Cardiology. Rodriguez Alfredo E , author in one chapter.Edited by Jean Marco, Jean Fajadet, Augusto Pichard, Henry Amor. Paris | |||||
| 1997 | Bertolasi. Cardiology 2000. Rodriguez Alfredo E , author in two Chapters. Restenosis and Multivessel Angioplasty. Editorial Panamericana, Buenos Aires, Argentina | |||||
| 1998 | Handbook of Coronary Stent. Rodriguez Alfredo E , author in one chapter. Editors by Patrick W. Serruys and Michael Kutryk. Editorial Martin Dunitz, London, Great Britain Interventional Cardiology in three continents .Edited by Jacques Puel, John Ambrose, Alfredo Rodríguez Interventional Cardiology in three continents .Edited by Jacques Puel, John Ambrose, Alfredo Rodríguez | |||||
| 2001 | Text book of High Risk Interventions. Editor Douglas Morrison – Editorial Saunders New York, USA. Author of the chapter, “Coronary stents and Surgery in High Risk Patients. A look From the South.” Rodriguez Alfredo E | |||||
| 2007 | Author of the chapter “Role of Systemic Antineoplasic Drugs in the Prevention of Restenosis after Percutaneous Stent Implantation”, of the book Textbook of Interventional Cardiovascular Pharmacology, edited by Nicolas Kipshidze, Jawad Fareed, Patrick W. Serruys and Jeff Moses | |||||
| 2009 | Author of the chapter “Comparative Randomized Studies between Angioplasty and Coronary Surgery: Lessons learned from studies ERACI I and ERACI II” in the book Cardiovascular Interventions SOLACI, edited by Amanda G.R.M. Sousa, Alexandre A. Abizaid, Marco Martinez Rios, Daniel Berrocal and J. Eduardo Sousa. Author of the chapter “Is Oral Rapamycin plus Bare Metal Stents a Feasible Alternative to Drug-Eluting Stents? Lessons learned from Argentina Observational and Randomized Studies (ORAR I, II and III Trials)” in the book Pharmacology in the Catheterization Laboratory, edited by Ron Waksman and Andrew Ajani. Chapter in the book “Cardiovascular emergencies in the elderly”, edited by Jorge E. Tronge. (confirmar año y capitulo) | |||||
| Papers published in peer reviewed journals | ||||||
| Rodriguez Alfredo E, Leguizamón JH, Cipolla L, Weinschelbaum E, Favaloro R, De la Fuente L M: Asymptomatic chronic infarction. Clinical angiographical correlation. Argentine J Cardiol 47/5: 322, 1979. Rodriguez Alfredo E, Leguizamón E, Caramutti V, Favaloro R, De la Fuente L M: Equivalent to lesions in the left coronary artery. Corde, year 1, vol 3: 1979. De la Fuente L M, Leguizamón J H, Patritti J P, Alvarez C, Rodriguez Alfredo E, Rojo H: Selective coronariography and its interpretation. Medicine J, first series, vol 18: 1362, 1979. Leguizamón D, Patritti J, Rodriguez Alfredo E, Vetcher D, De la Fuente L M: Normal x-ray picture anatony of coronary arteries. Corde, vol 3: 148, 1979. Vetcher D, Leguizamón J H, Patritti J P, Rojo H, Rodriguez Alfredo E, De la Fuente L M. Coronary: interpretation and diagnostic mistakes. Corde, vol 4:301, 1979. Rojo H, Rodriguez Alfredo E, De la Fuente L M: A study on the left ventricular function in the interauricular communication in the ostium secundum type. Arg. Cardiol J, vol 48: 264, Rojo H, Rodriguez Alfredo E, De la Fuente L M: A study on the left ventricular function in the interauricular communication in the ostium secundum type. Arg. Cardiol J, vol 48: 264, 1980. Rojo H, De la Fuente L M, Rodriguez Alfredo E, Zuffardi E, Favaloro R G: Non transmural acute infarction: clinical and angiographical foundings. Arg Cardiol J, vol 48, 6: 315, 1980. Rodriguez Alfredo E, Zuffardi E, Patritti J, Rojo H, Favaloro R, De la Fuente L M: Asymptomatic chronic infarction (ICA). A six year follow-up. Corde, year 1, vol 4: 231, 1980. Rodriguez Alfredo E, Zuffardi E, Rojo H, De la Fuente L M: Transluminal angioplasty: a preliminary report. Corde, year 2, vol 1: 19, 1981. Patritti J, Rodriguez Alfredo E, Zuffardi E, De la Fuente L M: Reversible asinergy. Corde year 2, vol 2: 120, 1981. Rodriguez Alfredo E, Díaz R, Zuffardi E, Navarro P, De la Fuente L M: Percutaneous transluminal coronary angioplasty. Argentine J Cardiol, 50, 2: 78, 1982. Rodriguez Alfredo E: Transluminal angioplasty. Coronary Thrombolysis. Book on Medical Sciences,University El Salvador, Buenos Aires, 1982. Rodriguez Alfredo E, Zuffardi E, Rojo H, Altman R, De la Fuente L M: Treatment of acute myocardial infarction by combination between the use of intracoronary fibrinolitics and transluminal angioplasty. Argentine J Cardiol, 50/5: 337, 1982. Rodriguez Alfredo E, Cohen A, Pichel R, Zuffardi E, Rojo H, Favaloro R G, De la Fuente L M: Changes in the left ventricular function post intracoronary thrombolysis in patients with acute transmural myocardial infarction. Argentine J Cardiol, 51/5: 305, 1982. 16. Rodriguez Alfredo E, Rojo H, Altman R, Weinschelbaum E, De la Fuente L M: Intracoronary fibrinolitics in acute myocardial infarction. A two year’s study. Corde, year 3, vol 4: 40, 1982. Rodriguez Alfredo E, Pichel R, Cabrera E, De la Fuente L M: Characteristics of the atheromatose plaque and possibilities for angioplasty dilatation. Corde, Year 4, vol 3: 27, 1983. Rodriguez Alfredo E, Bitonte G, D’Ortencio A, Rojo H, Zuffardi E, De la Fuente L M: Analysis of the factibility of transluminal coronary angioplasty in acute and subacute myocardial infarction. Argentine J Cardiol, 52/2: 169, 1983. Rodriguez Alfredo E, De la Fuente L M: Transluminal Coronary Angioplasty. Argentine J Cardiol, 12/4: 294, 1983. Rodriguez Alfredo E, Zuffardi E, Rojo H, Weinschelbaum E, Favaloro R, De la Fuente L M: Selective cinecoronariography in the evaluation pre-surgery for patients with aortic valvuloplasty. Corde, year 4, vol 3: 121, 1983. Rodriguez Alfredo E, Bordonava A, Gabe E: Coronary occlusion during transluminal angioplasty. Argentine J Cardiol, 53/10: 1984. Rodriguez Alfredo E, Cabrera E, Pichel R, Wisner J, Zuffardi E, De la Fuente L M: Clinical angiograhic predictors in the results of transluminal coronary angioplasty. Argentine J Cardiol, 57/1: 27, 1984 Rodriguez Alfredo E, Gabe E, De la Fuente L M: Physiopathogenia in the acute myocardial infarction. Corde. 26, 1984. Rodriguez Alfredo E: Transluminal coronary angioplasty. Editorial Corde, year 5, vol 2: 13, 1985. Rodriguez Alfredo E, Gallardo P, Bordonava A, De la Fuente L M: Transluminal coronary angioplasty in the transmural myocardial infarction after six hours. Corde, year 5, vol 4: 37, 1985. Rodriguez Alfredo E, Otero F, Pérez Baliño N, Lugones M: Reduction of the degree of obstruction after thrombolytic therapy clinical and morphologic factors. Vol Cardiol, Chile, 5: 97, 1986. Rodriguez Alfredo E, Wisner J, Gallardo P, Risau G, De la Fuente L M: Aortic valvuloplasty using catheter in severe aortic stenosis in old people. Early and six month follow-up. Argentine J Cardiol, 31 – 542, 1987 Sarmiento R, Blugherman J, Rodriguez Alfredo E, Díaz R, Turri D, Bertolasi C: Possible link between acute myocardial infarction related to coronary artery narrowing and presence of a previous coronary event. Am J Cardiol, 60: 721, 1987. Rodriguez Alfredo E: Prognostic value of the coronariography. Where is the mistake? Argentine J Cardiol, 16/1: 13, 1987. Rodriguez Alfredo E, Wisner J, Peñaloza E, Santaera O, De la Fuente L M, Pérez Baliño N: Complex coronary angioplasty. Immediate and late results. Argentine J Cardiol, 55/3: 107, 1987. Cazzaniga M, Rodriguez Alfredo E, Bordonava A, Gamboa R, Castelli M, Vitaco M, Dietl C: Therapeutic cardiovascular catheterization in children and teen-agers. Corde, year 8, vol 1: 49, 1987. Rodriguez Alfredo E, Santaera O, Lugones M, De la Fuente L M, Pérez Baliño N: Clinical angiographic correlates in the transmural acute infarction using thrombolitics. Medicina J 48: 132, 1988. Rodriguez Alfredo E, Santaera O, Risau G, Sosa Liprandi M I, Díaz R, Pérez Baliño N, Lugones M: Early angiographic study post successful angioplasty. Predictor of late restenosis. Medicina J 50: 505, 1990. Rodriguez Alfredo E: Coronary restenosis. Therapeutics Hyphotesis, 19/3: 203, (Editorial).Rev. Fed. Arg. Cardiol, 1990. Rodriguez Alfredo E, Santaera O, Fernandez M, Szejnfeld M, Sosa Liprandi M I, Pérez Baliño N, Risau G: Digital coronary angiography. A new view in the analysis of the atherosclerotic plaque. Medicina J 51: 209, 1991. Rodriguez Alfredo E: Coronary angiographic quantification and functional assesment. Federation Journal of Cardiology Editorial, 20/2: 97, 1991. Rodriguez Alfredo E, Santaera O, Fernández M. Digital angiographic in the diagnosis of Coronary Disease. Intercontinental Cardiology Journal, 1, 2, 25, 1992. Rodriguez Alfredo E, Perez Baliño N: Coronary angioplasty in multiple obstructions. Is it the first option in revascularization? Arg J Cardiol, 60/4: 1992. (Editorial). Rodriguez Alfredo E: Angiographic analysis of the coronary obstruction in acute and chronic ischemia. Chapters on Cardiology, edited by the Arg Soc of Cardiol, 1992. Rodriguez Alfredo E: Coronary restenosis mechanisms. Chapters on Cardiology, edited by the Arg Soc of Cardiol, 1992. Rodriguez Alfredo E, Boullón F, Pérez Baliño N, Sosa Liprandi M I, Mele E, Santaera O, Paviotti C, Palacios I.”Argentine randomized trial coronary angioplasty vs. by pass surgery in hospital results and one year follow-up (ERACI)”. J Am Coll. Cardiol 22: 1060, 1993. Rodriguez Alfredo E, Santaera O, Larribau M, Sosa Liprandi M I, Palacios I. “Early decrease in minimal luminal diameter after successful PTCA predicts late restenosis”. Am J Cardiol 1993; 71:1391-1395. Pérez Baliño N, Masoli O, Rodriguez Alfredo E, Iturria M, Martinez Sampere J J, Becerra D, Méndez R, Sporn V: Effort-rest isotopic ventriculography in asymptomatic patients after transluminal percutaneous angioplasty for clasifying high and low risk complications. Nuclear Med. Spanish J 12, 3: 129, 1993. Rodriguez Alfredo E, Boullon F, Perez-Baliño N, Paviotti C, Sosa Liprandi M, Palacios IF. “Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI): In-Hospital Results and 1-Year Follow-up”. J Am Coll Cardiol 1993; 22: 1060-7. Rodriguez Alfredo E: A new restenosis model. Arg J of Cardiol, 60, 341. (Editorial), 1993. Rodriguez Alfredo E. ”Director Core Laboratories for Angiography, the RAPT investigators: Randomized trial of Ridogrel, a combined Thrombexane A2 Synthase inhibitor and Thrombexane A2 / Protoglandin Endoperoxide receptor antagonist vs. Aspirin as adjunct to Thrombolysis in patients with acute myocardial infarction. The Ridogrel vs. Aspirine Patency Trial (RAPT)”. Circulation 89: 588, 1994. Rodriguez Alfredo E., Santaera O., Larribau M., Rojas R., Peyregne E., Mele E., Pérez Baliño. Primary PTCA in the treatmente of infarction. Clinical angiographic results. Arg. J of Cardiology, 62: 483 – 490, 1994. Rodriguez Alfredo E., Cristino A., Fernández M., Santaera O., Larribau M., Pérez Baliño N., Mele E. Role of PTA in the revascularization of symptomatic obstructions in supraortic vessels. Arg. J of Cardiol 62: 483 – 490, 1994 Rodriguez Alfredo E.: Randomized studies in myocardial revascularization ERACI, EAST, CABRI, GABI, RITA, new therapeutics modalities in ischaemic heart disease. Editorial Arg. J of Cardiol 1994. Rodriguez Alfredo E, Santaera O, Larribau M, Fernández M, Sarmiento R, Perez-Baliño N, Newell JB, Roubin G, Palacios I. “Coronary stenting decreases restenosis in lesions with early loss in luminal diameter 24 hours after successful PTCA”. Circulation 1995:91 1027-1042. 51. S. Pocock, R Henderson, Rodriguez Alfredo E, et al. “Meta analysis of randomized trials comparing coronary angioplasty with bypass surgery”. Lancet 1995; 346:1184-89 Rodriguez Alfredo E, Palacios I, Fernandez M et al. “Time course and mechanism of early luminal diameter loss after PTCA”. Am J Cardiol. 1995;76:1131-1134 Rodriguez Alfredo E, Fernandez M, Santaera O, Larribau M, Bernardi V, Castaño H, Palacios I. “Coronary stenting in patients undergoing percutaneous transluminal coronary angioplasty during Acute Myocardial Infarction”. Am J Cardiol 1996;77:685-689 Rodriguez Alfredo E, J Ambrose. Editorial. “Do we require a cure for stentmania´?” J Am Coll Cardiol 1996,28:827-9. Rodriguez Alfredo E, Mele E, Peyregne E, Boullon F, Perez Baliño N, Sosa Liprandi M, Palacios I “Three years follow up of the Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary bypass surgery in multivessel disease (ERACI)”. J Am Coll. Cardiol 1996;27:1178-84 N Perez Baliño, O Masoli, A Meretta,Rodriguez Alfredo E , D Cragnolino, S Perrone, F Boullon, E Mele, I Palacios, K Brown. “Amrinone Stimulation Test: Ability to Predict Improvement in Left Ventricular Ejection Fraction after Coronary Bypass Surgery in Patients With Poor Baseline Left Ventricular Function”. J Am Coll Cardiol 1996;28:1488-92 57. Rodriguez Alfredo E, Ayala F, Bernardi V, Santaera O, Marchand E, Pardiñas C, Mauvecin C, Vogel D, Harrell LC, Palacios I. “Optimal coronary balloon angioplasty with provisional stenting vs primary stent (OCBAS). Inmediate and Long-Term Follow-Up Results”. J Am Coll. Cardiol 1998; 32:1351-7. Rodriguez Alfredo E, Bernardi V, Fernadnez M, Mauvecin C, Ayala F, Santaera O, Martinez J, Mele, E, Roubin G, Palacios I, Ambrose J. “In-Hospital and Late Results of Cornary Stent versus Conventional Balloon Angioplasty in Acute Myocardial Infarction (GRAMI trial)”. Am J Cardiol 1998; 81: 1286-1291). Moreno P, Fallon J, Bernardi V, Harrel L, Weissman N, Fuster V, Rodriguez Alfredo E, Palacios I. Histopatology of Coronary lesions with early loss of minimal luminal diameter after succesfull percutaneous transluminal coronary angioplasty: Is the thrombus a significant contributor?J Am. Coll Cardiol, 1998; 136:804-811. Rodriguez Alfredo E. Stent trial in Acute Myocardial Infarction. J of Inv Cardiol, Vol 11, No 1, January 1999. Roqué F, Mon G, Belardi J, Rodriguez Alfredo E, Grinfeld L, Long R, Grossman S, Malcom A, Zon G, Ormont L. M, Fischman L. D, Shi Y and Zalewski A. Safety of Intracoronary Administration of c-myc Antisense Oligomers After Percutaneous Transluminal Coronary Angioplasty (PTCA). 2001, 11:99-106 Rodriguez Alfredo E; Bernardi V; Navia J; Baldi J; Grinfeld L; Martinez J; Vogel D; Grinfeld R; Delacasa A; Garrido M; Oliveri R; Mele E; Palacios I; O’Neill W on behalf of the ERACI II Investigators. “Argentine Randomized Study: Coronary Angioplasty with Stenting vs. Coronary Bypass Surgery In-Patients with Multiple Vessel Disease (ERACI II): 30 days and long term follow up results”. J. Am Coll. Cardiol, 2001 Jan;37(1):51-8. doi: 10.1016/s0735-1097(00)01052-4. Rodriguez Alfredo E. “The Role of Acute Wall recoil and late restenosis: Results of the OCBAS trial (Optimal Coronary Balloon Angioplasty with Provisional Stenting versus Primary Stent)“ Internantional Journal of Cardiovascular Interventions 2001; 4:99-10 Rodriguez Alfredo E. The Role of Acute Wall Recoil and Late Restenosis: Results of the OCBAS Trial (Optimal Coronary Balloon Angioplasty with Provisional Stenting versus Primary Stent). International Journal of Cardiovascular Interventions. Martin Dunitz Limited Editorial, 2001. Rodriguez Alfredo E, Rodriguez-Alemparte M, Baldi J, Navia J, Delacasa A, Vogel, Oliveri R, Fernandez-Pereira C, Bernardi V, O´Neill W, Palacios IF. “Coronary stenting versus coronary bypass surgery in patients with multiple vessel disease and significant proximal LAD stenosis: results frm the ERACI II study”. Heart 2003; 89: 184-188. David Antoniucci, MD, Rodriguez Alfredo E, MD, Albrecht Hempel, MD, Renato Valenti, MD, Angela Migliorini, MD, Federico Vigo, MD, Guido Parodi, MD, Carlos Fernandez-Pereira, MD, Guia Moschi, MD, Antonio Bartorelli, MD, Giovanni Maria Santoro, MD Leonardo Bolognese, MD, Antonio Colombo, MD “A Randomized Trial Comparing Primary Infarct Artery Stenting With or Without Abciximab in Acute Myocardial Infarction” J Am Coll Cardiol 2003;42:1879–85 Rodriguez Alfredo E, Carlos Fernandez Pereira, Maximo Rodriguez Elemparte “Oral Rapamycin in the treatment of diffuse proliferative in-Stent reestenosis in a patient with small reference vessel” Journal of Invas.Cardiol.2003; 15: 515-518. Rodriguez Alfredo E, Maximo Rodriguez Elemparte, MD, Cesar F Vigo, MD Carlos Fernandez Pereira, MD, Claudio Llauradó, Miguel Russo, MD, Renu Virmani, MD, PhD, John Ambrose, MD “Pilot Study of Oral Rapamycin to prevent reestenosis in patients undergoing coronary stent therapy: Argentine single-Center Study (ORAR Trial)” J Invas Cardiol 2003;15. David Antoniucci, MD; Angela Migliorini, MD; Guido Parodi, MD; Renato Valenti, MD; Rodriguez Alfredo E, MD; Albrecht Hempel, MD; Gentian Memisha, MD; Giovanni Maria Santoro, MD “Abciximab-Supported Infarct Artery Stent Implantation for Acute Myocardial Infarction and Long-Term Survival A Prospective, Multicenter, Randomized Trial Comparing Infarct Artery Stenting Plus Abciximab With Stenting Alone” Circulation. 2004;109:1704-1706 Rodriguez Alfredo E, Maximo Rodriguez Elemparte MD, Carlos Fernandez Pereira MD, Alberto Sampaolesi MD, Ronaldo da Rocha Loures Bueno MD, Federico C Vigo MD, Angel Obregón MD, Igor Palacios MD, “Latin American randomized trial of balloon angioplasty vs coronary stenting for small vessels (LASMAL): Immediate and long- term results” AJM. 2005; 118,743-751. Rodriguez Alfredo E, Maximo Rodriguez Alfredo Elemparte MD, Carlos Fernandez Pereira MD, Cesar F Vigo MD, Alberto Sampaolesi MD, Victor Bernardi MD, Eugenio Marchand MD, Jorge Tronge MD, Igor F Palacios MD. “Latin American randomized trial of balloon angioplasty vs coronary stenting in diabetic patients with small vessel reference size (Latin American Small Vessel [LASMAL II] Trial): Immediate and long- term results”.Am heart J 2005; 150: 188. e1-188.e7.. Rodriguez Alfredo E, Julio Baldi MD, Carlos Fernandez Pereira MD, Jose Navia MD, Maximo Rodriguez Alfredo Elemparte, MD, Alejandro Delacasa MD, Federico Vigo MD, Daniel Vogel MD, William O´Neill MD, Igor Palacios MD on behalf of the ERACI II Investigators “Five–Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II)”.-J Am Coll Cardiol 2005; 46:582-8 Rodriguez Alfredo E, Maximo Rodriguez Alfredo Elemparte, MD, Carlos Fernandez Pereira MD, Claudio Llauradó, David Vetcher MD, Antonio Pocoví MD, Jhon Ambrose MD.“Role of oral rapamycin to prevent restenosis in patients with de novo lesions undergoing coronary stenting: results of the Argentina single centre study (ORAR Trial)”.- Heart January 2005;91:1433-1437 Mercado N, Wijns W, Serruys PW, Sigwart U, Flather M, Stables RH, O´Neill W, Rodriguez Alfredo E, Lemos P, Hueb WA, Gersh BJ, Phill D, Booth J, Boersma E. “One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: A meta-analysis of individual patient data from randomized clinical trials”. Journal of Thoracic and Cardiovasc Surgery, Vol 130:2, 512-519. Rodriguez Alfredo E, Carlos Fernandez Pereira MD, Maximo Rodriguez Alfredo Elemparte, MD, “Oral Sirolimus After Bare Metal Stent Implantation in De Novo Lesions” CCI 06-0026 (Catheterization and Cardiovascular Interventions) 2006 Rodriguez Alfredo E, O´Maree A, Grinfeld L, Fernandez-Pereira C, Mieres J, Rodriguez-Alemparte M, Russo Felsen M, Oneill W, Palacios I. “Revascularization strategies of coronary musltiple vessel disease in the Drug Eluting Stent Era: One year follow-up results of the ERACI III Trial”. EuroIntervention. 2006 May; 2(1):53-60. Rodriguez Alfredo E, MD. Juan Mieres, Carlos Fernandez-Pereira, Cesar F Vigo, Maximo Rodriguez Elemparte, Daniel Berrocal, Liliana Grinfeld and Igor Palacios. “Coronary Stent Thrombosis in the Current Drug – Eluting Stent Era: Insights From the ERACI III Trial2006 Jan 3;47(1):205-7. doi: 10.1016/j.jacc.2005.10.016 Rodriguez Alfredo E , Juan Granada MD, Máximo Rodriguez- Alemparte MD, Cesar F Vigo MD*, Juan Delgado MD, Carlos Fernandez- Pereira MD*, Antonio Pocovi MD, Alfredo M Rodriguez –Granillo BS, Albert Raizner MD, Igor Palacios MD, William O Neill MD, Greg Kaluza MD,Gregg Stone MD.”Oral Rapamycin After Coronary Bare-Metal Stent Implantation to Prevent Restenosis: The Prospective, Randomized ORAR II (Oral Rapamycin in Argentina) Study”. JAAC 2006 March in Press. 2006 Apr 18;47(8):1522-9. doi: 10.1016/j.jacc.2005.12.052 Abizaid A, Chan C, Lim Y-T, Kaul U, Sinha N, Patel T, Tan H-C, Lopez-Cuellar J, Gaxiola E, Ramesh S, Rodriguez Alfredo E, Russell ME. “Twelve-Month Outcomes with a Paclitaxel-Eluting Stent Transitioning from Controlled Trials to Clinical Practice (the Wisdom Registry)”. Am J of Cardiol 8; 1028-1032. October 2006. Fernandez-Pereira C, Rodriguez-Granillo GA, Rodriguez Alfredo E. “Late stent thrombosis mimicking focal restenosis after sirolimus stent implantation: amgiographic and intravascular ultrasound appraisal”. J Invasive Cardio. 2006 Dec; 18(12): E294-7. Rodriguez Alfredo E, Rodriguez-Granillo GA, Palacios IF. “Late stent thrombosis: the Damocle´s sword of drug eluting stents”. EuroIntervention. 2007 Feb; 2(4): 512-7. Valgimigli M, Bolognese L, Anselmi M, Camnpo G, Rodriguez Alfredo E, de Cesare N, Cohen DJ, Sheiban I, Colangelo S, Pasquetto G, Hamon M, Vranckx P, Ferrario M, Prati F, Agostini P, Malagutti P, Arcozzi C, Parrinello G, Vassanelli C, Ferrari R, Percoco G. “Two-by-two factorial comparison of high-bolus dose tirofiban followed by standard infusion versus abciximab and sirolimus-eluting versus bare-metal stent implantation in patients with acute myocardial infarction:design and rationale for the MULTISTRATEGY trial”. Am Heart J. 2007 Jul; 154(1):39-45. Rodriguez Alfredo E, Andrew Maree, Juan Mieres, Daniel Berrocal, Liliana Grinfeld, Carlos Fernandez-Pereria, Valeria Curotto, Alfredo M Rodriguez-Granillo, William O´Neill, Igor F Palacios. “Late loss of early benefit from Drug-eluting stents when compared with bare-metal stents and coronary artery bypass surgery: 3 years follow-up of the ERACI III Registry”. EUR Hard J 2007. Rodriguez-Granillo GA, Rosales MA, Degrossi E, Durbano I, Rodriguez Alfredo E. “Modified scan protocol using multislice CT coronary angiography allows high quality acquisitions in obese patients: a case report”. Int J Cardiovasc Imaging. 2007 Apr; 23(2):265-7. Epub 2006 Jul 5. Rodriguez-Granillo GA, Rosales MA, Degrossi E, Durbano I, Rodriguez Alfredo E. “Multislice CT coronary angiography for the detection of burden, morphology and distribution of atherosclerotic plaques in the left main bifurcation”. Int j Cardiovasc Imaging. 2007 Jun; 23(3): 389-92. Epub 2006 Sep 23. Rodriguez Alfredo E, MD, PhD, Carlos Fernandez-Pereira, MD. “Systemic Immunosuppressive Therapy with Oral Sirolimus after Bare Metal Stent Implantation: The Missing Alternative in the Prevention of Coronary Restenosis after Percutaneous Coronary Interventions”. Recent Patents on Cardiovascular Drug Discovery, 2008, 3, 201-208. Marco Valgimigli, MD, PhD, Gianluca Campo, MD, Gianfranco Percoco, MD, Leonardo Bolognese, MD, Corrado Vassanelli, MD, Salvatore Colangelo, Nicoletta de Cesare, MD, Rodriguez Alfredo E, MD, PhD, Maurizio Ferrario, MD, Raul Moreno, Tommaso Piva, MD, Imad Sheiban, MD, Giampaolo Pasquetto, MD, Francesco Pratti, MD, PhD, Marco S. Nazzaro, MD, PhD, Giovanni Parrinello, PhD, Roberto Ferrari, MD, PhD. “Comparison of Angioplasty with Infusion of Tirofiban or Abciximab and With Implantation of Sirolimus-Eluting or Uncoated Stents for Acute Myocardial Infarction, The MULTISTRATEGY Randomized Trial.” Jama-Express, April 2008. Daemen J, Boersma E, Flather M, Booth J, Stables R, Rodriguez Alfredo E, Rodriguez-Granillo G, Hueb WA, Lemos PA, Serruys PW. “Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials”. Circulation. 2008 Sep 9;118(11):1146-54 Rodriguez Alfredo E, MD, PhD, Andrew Maree, MD, Igor Palacios, MD. “Quality of Life with PCI versus Medical Therapy in Stable Coronary Disease”. Number 21. NEJM. November 2008. Volume 359: 2289-2293. Gilberto Perez, MD, Alfredo M. Rodriguez-Granillo, BS, Juan Mieres, MD, Claudio Llaurado, Tech, Bibiana Rubilar, MD, Gustavo Risau, MD, Carlos Fernández-Pereira, MD, Rodriguez Alfredo E , MD, PhD. “New Coating Design for Patients with High-Risk Coronary Lesions for Thrombotic Events: Early and Long-Term Results of the Camouflage Registry.” Journal of Invasive Cardiology 2009; 21:378-382. Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J, Brooks MM, Carrié D, Clayton TC, Danchin N, Flather M, Hamm CW, Hueb WA, Kähler J, Kelsey SF, King SB, Kosinski AS, Lopes N, McDonald KM, Rodriguez Alfredo E, Serruys P, Sigwart U, Stables RH, Owens DK, Pocock SJ. “Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials”. Lancet. 2009 Apr 4; 373(9670):1190-7. Gaston A. Rodriguez-Granillo, MD, PhD, Miguel Rosales, MD, Francesca Pugliese, MD, PhD, Carlos Fernandez-Pereira, MD, Rodriguez Alfredo E, MD, PhD.”Prevalence and characteristics of major and minor coronary artery anomalies in an adult population assessed by computer tomography coronary angiography”. EuroIntervention. 2009 Mar; 4 online-publish-ahead-of-print January 2009. Gaston A. Rodriguez-Granillo, Miguel A. Rosales, Santiago Baum, Paola Rennes, Carlos Rodriguez-Pagani, Valeria Curotto, Carlos Fernandez-Pereira, Claudio Llaurado, Gustavo Risau, Elina Degrossi, Hernán C. Doval, Rodriguez Alfredo E. “Early Assessment of Myocardial Viability by the Use of Delayed Enhancement Computed Tomography after Primary Percutaneous Coronary Intervention”. JAAC Img. 2009; 2; 1072-1081. Rodriguez Alfredo E, MD, PhD, Andrew Maree, MD, Sonia Tarragona, Phd; Carlos Fernandez-Pereira, MD; Omar Santaera, MD; Alfredo M. Rodriguez-Granillo, BS; Gaston A. Rodriguez –Granillo, MD, Ph D; Miguel Russo-Felssen, MD; Neville Kukreja, MD; David Antoniucci, MD; Igor F. Palacios, MD; Patrick W. Serruys, MD, PhD. “Percutaneous coronary interventation with oral sirolimus and bare metal stents has comparable safety and efficacy to treatment with drug eluting stents, but with significant cost saving: long-term follow-up results from the randomised, controlled ORAR III (Oral Rapamycin in Argentina) study”. EuroIntervention May 2009; 5, 255-264. Rodriguez Alfredo E, Waksman R. “Sirolimus-Eluting Stents or Vascular Brachytherapy for In-Stent Restenosis After 3-Year Follow-UP of the SISR (Sirolimus-Eluting Stent Versus Vascular Brachytherapy for In-Stent Restenosis) Trial: A call for caution”. Letters to the editor. JACC: Cardiovasc Interv. 2009. Jan; 2 (1):75-6; Author Reply 76-7. Rodriguez Alfredo E, MD, PhD. “Emerging drugs for coronary restenosis: the role of systemic oral agents in the stent era”. Expert Opinion on Emerging drugs, August 2009. Rodriguez Alfredo E, MD, PhD, FACC, FSCAI. “Drug Eluting Stents: Balancing Risk and Benefits”. Cardiology Management, November 2009. Rodríguez-Granillo GA, Rosales MA, Renes P, Diez E, Pereyra J, Gomez E, De Lillo G, Degrossi E, Rodriguez Alfredo E, McFadden EP. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions. J Cardiovasc Comput Tomogr. 2010 Mar-Apr;4(2):99-107. Carlos, Fernández Pereira; Valeria, Curotto; Carlos, Rodríguez Pagani; María P., Renes; Alfredo, Rodríguez. Embolectomía percutánea reolítica en la tromboembolia pulmonar masiva / Percutaneous Rheolytic Embolectomy for Massive Pulmonary Embolism. Rev. argent. cardiol.; 78(5); 443-444; 2010-10 Comparison of AngioJet rheolytic thrombectomy before direct infarct artery stenting with direct stenting alone in patients with acute myocardial infarction. The JETSTENT trial. J Am Coll Cardiol. 2010 Oct 12;56(16):1298-306. Rodríguez-Granillo GA, Rosales MA, Llauradó C, Ivanc TB, Rodriguez Alfredo E. Guidance of percutaneous coronary interventions by multidetector row computed tomography coronary angiography. EuroIntervention. 2011 Jan;6(6):773-8. Valgimigli M, Campo G, Malagutti P, Anselmi M, Bolognese L, Ribichini F, Boccuzzi G, de Cesare N, Rodriguez Alfredo E, Russo F, Moreno R, Biondi-Zoccai G, Penzo C, Díaz Fernández JF, Parrinello G, Ferrari R. Persistent coronary no flow after wire insertion is an early and readily available mortality risk factor despite successful mechanical intervention in acute myocardial infarction: a pooled analysis from the STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) trials. JACC Cardiovasc Interv. 2011 Jan;4(1):51-62 Garg S, Sarno G, Serruys PW, Rodriguez Alfredo E, Bolognese L, Anselmi M, De Cesare N, Colangelo S, Moreno R, Gambetti S, Monti M, Bristot L, Bressers M, Garcia-Garcia HM, Parrinello G, Campo G, Valgimigli M; STRATEGY and MULTISTRATEGY Investigators. Prediction of 1-year clinical outcomes using the SYNTAX score in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a substudy of the STRATEGY (Single High-Dose Bolus Tirofiban and Sirolimus-Eluting Stent Versus Abciximab and Bare-Metal Stent in Acute Myocardial Infarction) and MULTISTRATEGY (Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study) trials. JACC Cardiovasc Interv. 2011 Jan;4(1):66-75. Rodriguez Alfredo E, Vigo CF, Delacasa A, Mieres J, Fernandez-Pereira C, Bernardi V, Bettinoti M, Rodriguez-Granillo AM, Rodriguez-Granillo G, Santaera O, Curotto V, Rubilar B, Tronge J, Palacios IF, Antoniucci D; EUCATAX Investigators. Efficacy and safety of a double-coated paclitaxel-eluting coronary stent: the EUCATAX trial. Catheter Cardiovasc Interv. 2011 Feb 15;77(3):335-42. Rodriguez-Granillo A, Rubilar B, Rodriguez-Granillo G, Rodriguez Alfredo E. Advantages and disadvantages of biodegradable platforms in drug eluting stents. World J Cardiol. 2011 Mar 26;3(3):84-92 Hlatky MA, Shilane D, Boothroyd DB, Boersma E, Brooks MM, Carrié D, Clayton TC, Danchin N, Flather M, Hamm CW, Hueb WA, Kahler J, Lopes N, Pocock SJ, Rodriguez Alfredo E, Serruys P, Sigwart U, Stables RH. The effect of internal thoracic artery grafts on long-term clinical outcomes after coronary bypass surgery. J Thorac Cardiovasc Surg. 2011 Oct;142(4):829-35 Ferrante G, Presbitero P, Corrada E, Campo G, Bolognese L, Vassanelli C, Colangelo S, De Cesare N, Rodriguez Alfredo E E, Bramucci E, Moreno R, Piva T, Sheiban I, Pasquetto G, Prati F, Nazzaro MS, Ferrari R, Valgimigli M. Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study trial. . Am Heart J. 2012 Jan;163(1):104-11 Mieres J, Fernandez-Pereira C, Rodriguez-Granillo AM, Rodriguez Alfredo E. Drug eluting or bare metal stents in cardiac allograft vasculopathy: the role of oral sirolimus. Catheter Cardiovasc Interv. 2012 Feb 15;79(3):496; author reply 497. Rodriguez Alfredo E. Productividad científica de la Cardiología y de las Sociedades de Cardiología: diferencias y similitudes de la Argentina con la región y los países centrales / Scientific Production by Cardiologists and Scientific Societies of Cardiology: Differences and Similarities between Argentina and Regional and Central Countries. Rev. Argent. Cardiol.; 80(1); 53-59; 2012-01 Mieres J, Rodriguez Alfredo E. Stent selection in patients with myocardial infarction: drug eluting, biodegradable polymers or bare metal stents? Recent Pat Cardiovasc Drug Discov. 2012 Aug;7(2):105-20. Review. Rodriguez Alfredo E, Fernández-Pereira C, Rodríguez-Granillo AM. Changes in the safety paradigm with percutaneous coronary interventions in the modern era: Lessons learned from the ASCERT registry. World J Cardiol. 2012 Aug 26;4(8):242-9. Rodriguez Alfredo E, Rodriguez-Granillo AM, Antoniucci D, Mieres J, Fernandez-Pereira C, Rodriguez-Granillo GA, Santaera O, Rubilar B, Palacios IF, Serruys PW; ORAR III Investigators. Randomized comparison of cost-saving and effectiveness of oral rapamycin plus bare-metal stents with drug-eluting stents: three-year outcome from the randomized oral rapamycin in Argentina (ORAR) III trial. Catheter Cardiovasc Interv. 2012 Sep 1;80(3):385-94. Mieres J, Fernandez-Pereira C, Risau G, Solorzano L, Pauletto R, Rodriguez-Granillo AM, Rubilar B, Stella P, Rodriguez Alfredo E. One-year outcome of patients with diabetes mellitus after percutaneous coronary intervention with three different revascularization strategies: results from the Diabetic Argentina Registry (DEAR). Cardiovasc Revasc Med. 2012 Sep-Oct;13(5):265-71 Flather M, Rhee JW, Boothroyd DB, Boersma E, Brooks MM, Carrié D, Clayton TC, Danchin N, Hamm CW, Hueb WA, King SB, Pocock SJ, Rodriguez Alfredo E, Serruys P, Sigwart U, Stables RH, Hlatky MA. The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials. J Am Coll Cardiol. 2012 Nov 20;60(21):2150-7 Rodriguez Alfredo E ; C Fernandez–Pereira; J Mieres; AM Rodriguez–Granillo; G Risau; R Pauletto; L Solorzano; D Antoniucci; PW Serruys. Comparison between oral rapamycin plus bare metal stent versus drug eluting stent for the prevention of restenosis in the treatment of coronary disease with PCI: Five-years final results from the ORAR III trial. J Am Coll Cardiol. 2013;61(10_S) (ABSTRACT) Valgimigli M, Campo G, Gambetti S, Bolognese L, Ribichini F, Colangelo S, de Cesare N, Rodriguez Alfredo E, Russo F, Moreno R, Piva T, Sheiban I, Penzo C, Prati F, Nazzaro MS, Díaz Fernández JF, Vassanelli C, Parrinello G, Ferrari R; MULTIcentre evaluation of Single high-dose bolus TiRofiban versus Abciximab with sirolimus eluting sTEnt or Bare Metal Stent in Acute Myocardial Infarction studY Investigators. Three-year follow-up of the MULTIcentre evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting STEnt or Bare-Metal Stent in Acute Myocardial Infarction StudY (MULTISTRATEGY). Int J Cardiol. 2013 Apr 30;165(1):134-41. Rodriguez Alfredo E. Are drug-eluting stents superior to bare metal stents when compared to coronary artery bypass surgery? Show me the data. Cardiovasc Revasc Med. 2013 Mar-Apr;14(2):90-2 Fernandez-Pereira C, Mieres J, Rodriguez Alfredo E. Lack of clinical benefit of drug-eluting compared to bare-metal stents for treatment of transplant coronary artery disease: why we do not need drug-eluting stents? Catheter Cardiovasc Interv. 2013 Aug 1;82(2):237. Waksman R, Serra A, Loh JP, Malik FT, Torguson R, Stahnke S, von Strandmann RP, Rodriguez Alfredo E. Drug-coated balloons for de novo coronary lesions: results from the Valentines II trial. EuroIntervention. 2013 Sep;9(5):613-9. Rodriguez-Granillo GA, Rodriguez Alfredo E, Bruining N, Milei J, Aoki J, Tsuchida K, del Valle-Fernández R, Arampatzis CA, Ong AT, Lemos PA, Ayala F, Garcia-Garcia HM, Saia F, Valgimigli M, Regar E, McFadden E, Biondi-Zoccai G, Barbenza E, Schoenhagen P, Serruys PW. Quantification of scientific output in cardiovascular medicine: a perspective based on global data. EuroIntervention. 2013 Dec;9(8):975-8. Parodi G, Migliorini A, Rodriguez Alfredo E. Thrombus aspiration during myocardial infarction. N Engl J Med. 2014 Feb 13;370(7):675 Rodriguez Alfredo E, Arismendi L, Romero G, Rodríguez-Granillo AM. Randomized trials of PCIs versus CABG surgery: why coronary stenting should remain the first choice of revascularization in non-diabetic patients and why the controversy is still present in diabetics. Expert Rev Cardiovasc Ther. 2014 Mar;12(3):297-309. Rodriguez Alfredo E, Palacios I, Rodriguez-Granillo AM, Mieres JR, Tarragona S, Fernandez-Pereira C, Solorzano L, Pauletto R, Serruys PW, Antoniucci D; ORAR-3 investigators. Comparison of cost-effectiveness of oral rapamycin plus bare-metal stents versus first generation of drug-eluting stents (from the Randomized Oral Rapamycin in Argentina [ORAR] 3 trial). Am J Cardiol. 2014 Mar 1;113(5):815-21. Rodriguez Alfredo E, Fernandez-Pereira C, Mieres J. Coronary artery bypass grafting vs percutaneous coronary intervention in multivessel disease. JAMA Intern Med. 2014 Jun;174(6):1007. Rodriguez Alfredo E. Coronary artery bypass surgery or coronary stenting in Diabetic patients: Too soon to make a statement? Cardiovascular Revascularization Medicine (in press) Dangas G, Farkouh M, Sleeper LA, Yang M, Schoos MM, Macaya C, Abizaid A, Buller C, Devlin G, Rodriguez Alfredo E, Lansky A, Siami S, Domanski M, Fuster V for the FREEDOM Investigators. Long Term Outcome of PCI versus CABG in Insulin and Non-Insulin Treated Diabetic Patients: Results from the FREEDOM Trial. JACC (in press) Cassese S, De Luca G, Ribichini F, Cernigliaro C, Sansa M, Versaci, Proietti I, Stankovic G, Stojkovic S, Fernandez-Pereira C, Tomai T, Vassanelli C, Antoniucci D, Serruys PW, Kastrati A, .Rodriguez Alfredo E. ORAl iMmunosuppressive therapy to prevent in-Stent rEstenosiS (RAMSES) cooperation: a patient-level meta-analysis of randomized trials Atherosclerosis (in press). J Mieres, M Menéndez, C Fernández-Pereira, J Baldi (h), S<M Grosso, M Rubio, Rodriguez Alfredo E . Acceso transapical percutáneo de válvula aórtica con prótesis de JenaValve: experiencia inicial del Departamento de Cardiología del Sanatorio Otamendi. Revista Argentina de Cardioangiología 2014;5(04 ):0268 -0273 Rodriguez Alfredo E , PalaciosI,Rodriguez-GranilloAM,MieresJR,TarragonaS,Fernandez PereiraC,SolorzanoL,PaulettoR,SerruysPW,Antoniucci D; ORAR-3 investigators. Comparison of cost-effectiveness of oral rapamycin plus bare-metal stents versus first generation of drug-elutingstents (from the Randomized Ora lRapamycinin Argentina [ORAR]3 trial). AmJCardiol.2014Mar1;113(5):815-21- R Cristódulo-Cortez, BR Ugarte, J Aldana-Robinson, AM Rodríguez Granillo, C Fernández-Pereira, C Mauvecin, J Mieres, Rodriguez Alfredo E . Resultados hospitalarios y alejados del stent carotídeo de una serie consecutiva: relación con el uso de sistemas de protección cerebral. Revista Argentina de Cardioangiología 2014;5(03 ):0197-0202 C Fernández Pereira, AM Rodríguez-Granillo, R Cristódulo-Cortés, J Mieres, P Renes, F Calvo, B Ugarte, J Robinson Aldana, Rodriguez Alfredo E . Tratamiento de la embolia pulmonar masiva con trombectomía reolítica percutánea: resultado intrahospitalario y al seguimiento. Revista Argentina de Cardioangiología 2014;5(02 ):0130-0136. Rodriguez Alfredo E , Roberto Cristódulo-Cortez, Benjamín R Ugarte, Jhon Aldana-Robinson, Alfredo M Rodríguez Granillo, Carlos Fernández-Pereira, Carlos Mauvecin, Juan R Mieres.Resultados hospitalarios y alejados del stent carotídeo de una serie consecutiva: relación con el uso de sistemas de protección cerebral Revista Argentina de Cardioangiología 2014;(03):0197-0202 Rodriguez Alfredo E . No todos somos iguales… ¿y los diabéticos? Revista Argentina de Cardioangiología 2014;(02):0116-0117 J Mieres, M Menéndez, C Fernández Pereira, J Baldi (h), S M Grosso, M Rubio, Rodriguez Alfredo E Alfredo Eceso transapical percutáneo de válvula aórtica con prótesis de JenaValve: experiencia inicial del Departamento de Cardiología del Sanatorio Otamendi Revista Argentina de Cardioangiología 2014;(04):0268-0274 C Fernández Pereira, M Rodríguez Granillo, R Cristódulo Cortés, J Mieres, P Renes, FCalvo, B Ugarte, J Robinson Aldana, Rodriguez Alfredo E .Tratamiento de la embolia pulmonar masiva con trombectomía reolítica percutánea: resultado intrahospitalario y al seguimiento,Revista Argentina de Cardioangiología 2014;(02):0130-0136 Rodriguez Alfredo E ¿Cuál es el tiempo adecuado de doble antiagregación plaquetaria luego del implante de stents liberadores de fármacos?,Revista Argentina de Cardioangiología 2014;(04):0244-0244 Rodriguez Alfredo E .Este número en la Revista Argentina de Cardioangiología Intervencionista (RACI),Revista Argentina de Cardioangiología 2014;(01):0011-0011 Rodriguez Alfredo E , C Fernández-Pereira, O Santaera, M Larribau, C Haiek, R Sarmiento, J Mieres, J Lloveras, A Pocoví, O Carlevaro, I Rifourcat, J Chen, K Zheng, A M Rodríguez-Granillo, D Antoniucci. Revascularization strategies for patients with multiple vessel coronary disease and unprotected left main. A prospective, multicenter and controlled Argentina registry with a cobalt-chromium rapamycin eluting stent, Revista Argentina de Cardioangiología 2014;(01):0019-0025 140. Mieres J, Menéndez M, Fernández-Pereira C, Rubio M, Rodriguez Alfredo E. Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk. Case Rep Cardiol.2015;2015:458151 Rodriguez Alfredo E ,Fernandez-PereiraC,MieresJ,SantaeraO,AntoniucciD;ERACIIVinvestigators.Modifying angiographic syntax score according to PCI strategy: lessons learnt from ERACI IV Study. Cardiovasc Revasc Med. 2015 Jul 11. pii: S1553-8389(15)00182-7 142. D Antoniucci, Rodriguez Alfredo E . Dual antiplatelet therapy after drug-eluting stent implantation: long-term, short-term, tailored or related to stent type? Revista Argentina de Cardioangiología 2015;6(03 ):0126-0128 R Merhan, Rodriguez Alfredo E . Bleeding and thrombosis risk with bivalirudin and unfractionated heparin: re-visiting HORIZONZ, EUROMAX and HEAT-PPCI studies. Revista Argentina de Cardioangiología 2015;6(01):0013-0014 Rodriguez Alfredo E. Second versus first generation DES in multiple vessel disease and unprotected left main stenosis: insights from ERACI IV Study. Minerva Cardioangiol. 2015Aug;63(4):317-27 145 D Antoniucci, Rodriguez Alfredo E . Dual antiplatelet therapy after drug-eluting stent implantation: long-term, short-term, tailored or related to stent type?. Revista Argentina de Cardioangiología 2015;(03):0126-0128 146. D Antoniucci, Rodriguez Alfredo E . Dual antiplatelet therapy after drug-eluting stent implantation: long-term, short-term, tailored or related to stent type? Revista Argentina de Cardioangiología 2015;6(03 ):0126-0128 Rodriguez Alfredo E , Misconduct (mala conducta) de los investigadores en los estudios clínicos: reflexiones sobre un artículo de la Food and Drug Administration. Revista Argentina de Cardioangiología 2015;(03):0121-0123 D Paolantonio, G Sansoni,Rodriguez Alfredo E , GMatkovich. Aneurisma arteria renal gigante. Exclusión endovascular con stentgraft y seguimiento a largo plazo. Revista Argentina de Cardioangiología 2015;(02):0087-0091 D Antoniucci, Rodriguez Alfredo E . Dual antiplatelet therapy after drug-eluting stent implantation: long-term, short-term, tailored or related to stent type?. Revista Argentina de Cardioangiología 2015;(03):0126-0128 Rodriguez Alfredo E , R Merhan .Bleeding and thrombosis risk with bivalirudin and unfractionated heparin: re-visiting HORIZONZ, EUROMAX and HEAT-PPCI studies Revista Argentina de Cardioangiología 2015;(01):0013-0014 Barone A, Otero-Losada M, Grangeat AM, Cao G, Azzato F, Rodriguez Alfredo E, Milei J.Ozonetherapy protects from in-stent coronary neointimal proliferation. Role of redoxins.Int J Cardiol. 2016 Nov 15;223:258-261. doi: 10.1016/j.ijcard.2016.07.177. 152. Rodriguez Alfredo E, Pavlovsky H, Del Pozo JF.Understanding the Outcome of Randomized Trials with Drug-Eluting Stents and Coronary Artery Bypass Graft in Patients with MultivesselDisease: A Review of a 25-Year Journey.1. Clin Med Insights Cardiol. 2016 Dec 7;10:195-199 Charytan DM, Desai M, Mathur M, Stern NM, Brooks MM, Krzych LJ, Schuler GC, Kaehler J, Rodriguez-Granillo AM, Hueb W, Reeves BC, Thiele H, Rodriguez Alfredo E, Buszman PP, Buszman PE, Maurer R, Winkelmayer WC. Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronaryintervention in patients with chronic kidney disease. Kidney Int. 2016 Aug;90(2):411-21. doi: 10.1016/j.kint.2016.03.033. Rodriguez Alfredo E, Fernandez-Pereira C, Mieres J, Ascarrunz D, Gabe E, Rodríguez-Granillo AM, Frattini R, Stuzbach PVentricular Septal Perforation after Biventricular Takotsubo Cardiomyopathy Successfully Repaired with an Amplatzer Device: First Report inthe Literature. Case Rep Cardiol. 2016;2016:3251032. doi: 10.1155/2016/3251032. Haiek C, Fernández-Pereira C, Santaera O, Mieres J, Rifourcat I, Lloberas J, Larribau M, Pocoví A, Rodriguez-Granillo AM, Sarmiento RA, Antoniucci D, Rodriguez Alfredo ESecond vs. First generation drug eluting stents in multiple vessel disease and left main stenosis: Two-year follow-up of the observational, prospective, controlled, and multicenter ERACI IV registry. Catheter Cardiovasc Interv. 2017 Jan;89(1):37-46. doi: 10.1002/ccd.26468. Epub 2016 Mar 7. Rodriguez Alfredo E, Fernandez-Pereira C, Mieres J, Mendoza J, Sartori F. Can We Improve the Outcomes of Multivessel Disease Using Modified SYNTAX and Residual SYNTAX Scores Curr Cardiol Rep. 2017 Mar;19(3):20. doi: 10.1007/s11886-017-0833-2. Review Fernandez-Pereira C, Mieres J, Rodriguez Alfredo E Long-Term Mortality After Coronary Revascularization in Nondiabetic Patients With Multivessel Disease.. J Am Coll Cardiol. 2017 Jan 3;69(1):116-117. doi: 10.1016/j.jacc.2016.07.792. No abstract available. ERACI IV study. Rodriguez Alfredo E Reemplazo percutáneo de válvula aórtica: ¿es tiempo de moverse a grupos de menor riesgo?.Revista Argentina de Cardioangiología 2016;(02):0061-0065 159. Rodriguez Alfredo E Stents farmacológicos o metálicos en enfermedad arterial coronaria: reflexiones a partir de los hallazgos del estudio NORSTENT. Revista Argentina de Cardioangiología 2016;(03):0127-0128 Rodriguez Alfredo E Cardiopatías estructurales en la Revista RACI: una clara muestra del apoyo e interés mancomunado de toda la Cardiología IntervencionistaRevista Argentina de Cardioangiología 2016;(4):0189-0189 C Agatiello, A Candiello, M Sztejfman, C Fava, D Grinfeld, I Seropian, A Scuteri, A Damonte, J Mieres, H Londero, OMendiz, F Cura, D Berrocal, M Payaslian,Rodriguez Alfredo E , J A G Álvarez, C Cigalini, E Torresani Consenso del implante valvular aórtico percutáneo del Colegio Argentino de Cardioangiólogos Intervencionista 2016Revista Argentina de Cardioangiología 2016;(4):0194-0210 Rodriguez Alfredo E, Santaera O, Larribau M, Sarmiento R, Haiek C, Del Pozo JF, Pavlovsky H, Rodriguez-Granillo AM; ERACI IV Investigators.. Minerva Cardioangiol. 2017 Feb;65(1):81-90. doi: 10.23736/S0026-4725.16.04252-3. –Rodriguez Alfredo E .¿Qué se necesita para modificar la evidencia clínica?. Revista Argentina de Cardioangiología 2017;(1):0010-0011 Rodriguez Alfredo E . 1977/2017: 40 años de la angioplastia coronaria; historia y reconocimiento a los que marcaron el camino, y las contribuciones argentinas a la Cardiología Intervencionista. Revista Argentina de Cardioangiología 2017;(2):0056-0059 H Pavlovsky, C Fernández-Pereira, J Mieres, A M Rodríguez-Granillo, R Farfan, OSantaera, P Stutzbach, E Gabe, Rodriguez Alfredo E .Implante percutáneo de válvula aórtica en nonagenarios. Resultados hospitalarios y en el follow up. Revista Argentina de Cardioangiología 2017;(2):0067-0073 Rodriguez Alfredo E, Fernandez-Pereira C, Mieres J, Pavlovsky H, Del Pozo J, Rodriguez-Granillo AM, Antoniucci D Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.Cardiovasc Revasc Med. 2018 Feb 13. pii: S1553-8389(18)30014-9. doi: 10.1016/j.carrev.2018.01.012. Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez Alfredo E, Sabik JF 3rd, Stables RH, Stone GW, Serruys PW, Kappetein APMortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018 Mar 10;391(10124):939-948. doi: 10.1016/S0140-6736(18)30423-9. Epub 2018 Feb 23. Rodriguez Alfredo E, Rodriguez-Granillo AM, Ascarrunz SD, Peralta-Bazan F, Cho MY Did Prasugrel and Ticagrelor Offer the Same Benefit in Patients with Acute Coronary Syndromes after Percutaneous Coronary Interventions Compared to Clopidogrel? Insights from Randomized Clinical Trials, Registries and Meta-analysis. Curr Pharm Des. 2018;24(4):465-477. doi: 10.2174/1381612824666180108121834. Rodriguez Alfredo E Resultados relevantes del Congreso Europeo de Cardiología 2018 en Munich: hallazgos sorpresivos del estudio FUTURE Revista Argentina de Cardioangiología Intervencionista 2018;(03):0131-0132 169.Rodriguez Alfredo E Significativa reducción de la mortalidad con la cirugía de bypass aortocoronario sobre la angioplastia con stents: ¿El fin de la historia? Revista Argentina de Cardioangiología Intervencionista 2018;(01):0011-0014 170 Rodriguez Alfredo E Las lecciones aprendidas del estudio ORBITA: ¿Cuáles lecciones? Revista Argentina de Cardioangiología Intervencionista 2018;(02):0083-0084 171. Rodriguez Alfredo E Visibilidad y alcance editorial de la Revista Argentina de Cardioangiología Intervencionista (RACI) Revista Argentina de Cardioangiología Intervencionista 2018;(04):0194-0194 Rodriguez Alfredo E Visibilidad y alcance editorial de la Revista Argentina de Cardioangiología Intervencionista (RACI) Revista Argentina de Cardioangiología Intervencionista 2018;(04):0194-0194 Rodriguez Alfredo E.Cardiovasc The ORBIT A trial: Why is it not the last nail for coronary angioplasty in stable angina patients?Revasc Med. 2019 Jan;20(1):80-81. doi: 10.1016 Pavlovsky H, Rodriguez-Granillo AM, Rodriguez Alfredo E.J Am Coll Late Mortality After Drug-Eluting, Bare-Metal Stents, and Coronary Bypass Surgery in Left Main Disease Cardiol. 2019 Apr 9;73(13):1737. doi: 10.1016/j.jacc.2018.12.080. 175. Rodriguez Alfredo E En la búsqueda de más transparencia en la línea editorial Revista Argentina de Cardioangiología Intervencionista 2019;(01):0011-0012 Juan Mieres, Carlos Fernández-Pereira, Hernán Pavlovsky, Omar Santaera, Juan Del Pozo, Javier Mendoza, Francisco Peralta-Bazán, MatíasRodriguez Alfredo E -Granillo, Santiago Burda, Yazmín Navarro, Rodriguez Alfredo EAlfredo Eusencia de diferencias entre los accesos radial y femoral durante las intervenciones percutáneas coronarias. Resultados a 30 días de un registro prospectivo y consecutivo de pacientes Revista Argentina de Cardioangiología Intervencionista 2019;(02):0063-0067 Carlos Fernández-Pereira, Juan Mieres, Hernán Pavlovsky, Laura Bidegain, Alfredo. E Rodríguez Implante percutáneo de válvula aórtica sobre válvula protésica estenótica valve in valve con técnica de cracking: primer reporte de un caso en Argentina Revista Argentina de Cardioangiología Intervencionista 2019;(02):0078-0082 178. Rodriguez Alfredo E Selección de drogas antiplaquetarias después del ISAR-REACT 5: ante un nuevo paradigma o la confirmación de datos previos Revista Argentina de Cardioangiología Intervencionista 2019;(03):0105-0106 A M Rodríguez-Granillo, C Haiek, M Larribau, C Fernández-Pereira, J Mieres, R Sarmiento, A Pocoví, M Menéndez, J Lloberas, E Sisú, J Iravedra, M Montoya, I Rifourcat, O Santaera, Z Ming, W Pan, Rodriguez Alfredo E Uso de drogas inhibidoras de P2Y12, clopidogrel, prasugrel y ticagrelor, en pacientes sometidos a intervenciones coronarias percutáneas en el mundo real en la Argentina. Resultados de los Registros ERACI IV y WALTZ Revista Argentina de Cardioangiología Intervencionista 2019;(03):0111-0116 Rodriguez Alfredo E Visibilidad, alcance Editorial y crecimiento de la Revista Argentina de Cardioangiología Intervencionista (RACI) 2018/2019 Revista Argentina de Cardioangiología Intervencionista 2019;(04):0148-0149 Mieres J, Rodriguez Alfredo E , Fernández-Pereira C, Ascarrunz-Cattoretti D Increased incidence of serious late adverse events with drug-eluting stents when compared with coronary artery bypass surgery: a cause of concern .Future Cardiol. 2020 Jul 9. doi: 10.2217/fca-2020-0033. Online ahead of print. Rodriguez Alfredo E Declinación en el uso de los métodos de revascularización y de angioplastia coronaria en Estados Unidos: Previsible pero muy preocupante Revista Argentina de Cardioangiología Intervencionista 2020;(01):0013-0014 Rodriguez Alfredo EAlfredo Ennual decrease in the number of percutaneous coronary interventions performed in the United States: a cause for concern Revista Argentina de Cardioangiología Intervencionista 2020;(1):0011-0011 Rodriguez Alfredo E Eduardo Gabe MD, PhD, FACC (1953-2020). In memoriam Revista Argentina de Cardioangiología Intervencionista 2020;(02):0057-0057 A Matías Rodríguez-Granillo, Hernán Pavlovsky, Camila Correa-Sadouet, Camila Gallardo, Axel Vitale, María V Curotto, Carlos Fernández-Pereira, Juan Mieres, Ricardo Pérez de la Hoz, Rodriguez Alfredo E . Presentation of the acute myocardial infarction with elevantion of the ST-T segment in a center of the city of Buenos Aires during COVID-19 pandemic. Revista Argentina de Cardioangiología Intervencionista 2020;(02):0070-0072 Rodríguez-Granillo AM, Pavlovsky H, Correa-Sadouet C, Gallardo C, Vitale A, Curotto MV, Fernández-Pereira C, Mieres J, Pérez de la Hoz R, Rodriguez Alfredo E. ST-Segment elevation myocardial infarction in a Buenos Aires center during the current COVID-19 pandemic Revista Argentina de Cardioangiología Intervencionista 2020;(2):0070-0072 | ||||||
| Abstracts | ||||||
| Londero H, Picabea E, Rodriguez Alfredo E , De la Fuente L M: Value of the several variables of ventricular function taken from the ventriculogram in the detection of small alterations focused in the ventricular contraction. Arg Soc Cardiol Congress, 1975.Londero H, Picabea E, Rodriguez Alfredo E , Ruda Vega M, De la Fuente L M: A study of left ventricular function through the cineventriculogram in the recent angina. VI Congress Arg Soc Cardiol, Nov 1976.Londero H, Picabea E, Rodriguez Alfredo E , De la Fuente L M: Methods for the detection of ischaemia in the ventricular contraction through the cineventriculogram. VI Congress Arg Soc Cardiology, Nov 1976.Vetcher D, Rodriguez Alfredo E , Patritti J, Leguizamón J, De la Fuente L M: Clinical and angiographicfindings in persistent acute ischemia. VI Congress Arg Soc Cardiol, Nov 1978.Rodriguez Alfredo E , Vetcher D, Gurevich D, Barberá M, Sevilla D, De la Fuente L M, Favaloro R: A multiform entity. Arg Fed Cardiol, Córdoba, Argentina, Dec 1978.Rodriguez Alfredo E , Leguizamón J, Patritti J, Favaloro R N, De la Fuente L M: Left main equivalents. V Congress Arg Soc Cardiol, August 1979.Rojo H, Patritti J, Vetcher D, Rodriguez Alfredo E , Zuffardi E, De la Fuente L M: Clinical and angiographic analysis of the left ventricular function in the mitral insuficiency post acute myocardial infarction. VI Congress Arg Soc Cardiol, Sept 1979.Wisner J, Rodriguez Alfredo E , Zeballos I, Favaloro R G, De la Fuente L M: Incidence of coronariopathy in asymptomatic patients with some manifestations of atherosclerotic disease in orther fields. VI Congress Arg Soc Cardiol, Sept 1980.Molteni S, Rodriguez Alfredo E , Rojo H, De la Fuente L M: Clinical and angiographic correlation in women with recent angor, progressive angor and stable angor grade III-IV. XVIII Congress Arg Soc Cardiol, 1981.Gabe E, Rojo H, Rodriguez Alfredo E , Cabrera E, De la Fuente L M: Clinical and angiographic correlation and left ventricular function on recent angina. XVIII Congress Arg Soc Cardiol, 1981.Crudo N, Sarubbi A, Rabuini M, Trongé J, Rodriguez Alfredo E : Comparative analysis of the natural development in two prospective studies on recent angina. XVIII Congress Arg Soc Cardiol, 1981.Pérez Baliño N, Zeballos I, Sporn N, Rodriguez Alfredo E , Zuffardi E, De la Fuente L M: Analysis of the isotopic ventriculogram in patients with suspected coronary spasm. XVIII Congress Arg Soc Cardiol, 1981.Bertolasi C, Trongé J, Lugones M, Belardi J (Inst. Pombo), Oliveira J D (Hosp. Militar), Gómez Llambí (Hosp. Italiano), Machi R (Hosp. Español), Richitelli M (Hosp. Argerich), Rodriguez Alfredo E (Sanat. Güemes), Rosenthal R (Hosp. Durand): Sudden death. A multi-center study, high hemodynamic risk. Preliminary report. XVIII Congress Arg Soc Cardiol, 1981.Sporn V, Pérez Baliño N, Lugones M, Rodriguez Alfredo E , Bruno C: Stress test with Thalium 201 in patients with chronic myocardial infarction. XVIII Congress Arg Soc Cardiol, 1981.Wisner J, Pérez Baliño N, Sporn V, Rojo H, Rodriguez Alfredo E , De la Fuente L M: Behavior of ejection fraction and parietal motility as for angor and during the ergometric effort. XVIII Congress Arg Soc Cardiol, 1981.Pérez Baliño N, Sporn V, Gabe E, Bruno C, Rodriguez Alfredo E , De la Fuente L M: A study of the left ventricular function in patients without and with ischemic cardiopathy during the ergometric study through the use of gamma camera. Cinecoronariographic correlation. XVIII Congress Arg Soc Cardiol, 1981.Weinschelbaum E, Rodríguez Campos J, Rodriguez Alfredo E , Caramutti V, Favaloro R: Surgical treatment for arteriovenous fistula in a case of a big congenital in the right hemitorax. XVIII Congress Arg Soc Cardiol, 1981.Pérez Baliño N, Trongé J, Rodriguez Alfredo E , Zuffardi E: Assessment of radionuclide ventriculogram in patients with suspected coronary spasm. IX World Congress of Cardiology, Moscow, URSS, June 1982.Weinschelbaum E, Rojo H, Boullón F, Caramutti V, Favaloro M, Rodriguez Alfredo E , De la Fuente L M, Favaloro R: Non transmural myocardial infarction. Surgical treatment and late follow-up. IX World Congress of Cardiology, Moscow, URSS, June 1982.Weinschelbaum E, Rojo H, Rodriguez Alfredo E , De la Fuente L M, Favaloro R: Pre and post-operative left ventricular function at rest and during ergometric test in patients with previously normal left ventriculogram. IX World Congress of Cardiology, Moscow, URSS, June 1982.Rodriguez Alfredo E , Rojo R, Díaz R, Altman R, Zeballos I, De la Fuente L M: Transluminal recanalyzation in acute myocardial infarction (AMI), a case. Congress Arg Fed Cardiol, May 1982.Cabrera E, Rodriguez Alfredo E , Cors J, De la Fuente L M, Zuffardi E, Petronio C: Transluminal angioplasty in legs: results and correlation with arterial fluxometry through Doppler. Congress Arg Sociedad Cardiol, August 1982.Gabe E, Rodriguez Alfredo E , Pérez Baliño N, Rojo H, Molteni S, De la Fuente L M: Changes of response to exercise in patients with transluminal coronary angioplasty Congress of Cardiol, October 1982.De la Fuente L M, Rodriguez Alfredo E , Rojo H, D’Ortencio A: Clinical and angiographic correlates in acute and sub myocardial infarction. V European Congress of Cardiology, Bordeaux, France, September 1983.Altman A, Rodriguez Alfredo E , Ghanem J, De la Fuente L M: Thrombolysis in acute myocardial infarction. Changes in blood coagulation parameters. Thromb & Harmost: 50-408, 1983.Rodriguez Alfredo E , Cazenave C, Weinschelbaum E, Rojo H, Favaloro R, De la Fuente L M: Changes in the left ventricular function after intracoronary thrombolysis in the acute myocardial infarction. XIX Congress of Cardiol, Tucumán, Sept 1983.D’Ortencio A, Rodriguez Alfredo E , Bitonte C, Rojo H, Favaloro R, De la Fuente L M: Degree of coronary obstruction in the acute myocardial infarction without complications. XIX Congress of Cardiol, Tucumán, Sept 1983.Cabrera E, Rodriguez Alfredo E , Gabe E, Zuffardi E, De la Fuente L M, Figueroa H: Correlation among the results of transluminal coronary angioplasty, the type of atherosclerotic plaque and the clinical aspects. XIX Congress of Cardiol, Tucumán, Sept 1983.Ale J, Pérez Baliño N, Dorao N, Rodriguez Alfredo E , Sporn V, De la Fuente L M: Analysis of the radioisotopic ventriculogram and the myocardial perfussion with Thalium 201. XIX Congress of Cardiol, Tucumán, Sept 1983.Wisner J, Rodriguez Alfredo E , Rojo H, Weinschelbaum E, Favaloro R, De la Fuente L M: Intracoronary Thrombolysis in acute myocardial infarction. General Results. XIX Congress of Cardiol, Tucumán, Sept 1983.Gabe E, Rodriguez Alfredo E , Roubier J, Ghanem J, Altman R, De la Fuente L M: Thrombolysis in acute myocardial infarction. Changes in the factors of coagulation in peripheral arterial blood. XIX Congress of Cardiol, Tucumán, Sept 1983.Caramutti V, Wisner J, Rodriguez Alfredo E , Weinschelbaun E, Favaloro R, De la Fuente L M: Myocardial revascularization surgery in patients with acute myocardial infarction recanalized through intracoronary thrombolysis. XIX Congress of Cardiol, Tucumán, Sept 1983.D’Ortencio A, Rojo H, Bitonte C, Rodriguez Alfredo E , De la Fuente L M: Analysis of the indexes of the ventricular ejective period in angina post acute myocardial infarction in anterior wall. XIX Congress of Cardiol, Tucumán, Sept 1983.Festa H, Rojo H, Rodriguez Alfredo E , Bordonava A, Cabrera E, De la Fuente L M: «Hexabrix», a new contrasting material in pediatric angiocardiography. XIX Congress of Cardiol, Tucumán, Sept 1983.Wisner J, Rodriguez Alfredo E , Cohen A, Altman R, De la Fuente L M: Coronary Thrombolysis in acute myocardial infarction. Comparison of results between intracoronary and peripheral vein. Congress Arg Soc Cardiol, August 1984.Pérez Baliño N, Dorao T, Rodriguez Alfredo E , Zuffardi E, Sporn V: Incidence of coronary disease in cardiologic centers. XIV Congress Arg Soc Cardiol, Sept 1985.Rizzo T, Pérez Baliño N, Masoli O, Sosa Liprandi M I, Rodriguez Alfredo E , Sporn V: Use of radioisotopic ventriculogram TC 99 in the diagnostic of ischemic cardiopathy during ergometric tests. XIV Congress Arg Soc Cardiol, Sept 1985.Gallardo P, Rodriguez Alfredo E , Bordonava A, De la Fuente L M: Incidence of the total occlusion during coronary angioplasty. XIV Congress Arg Soc Cardiol, Septiembre de 1985.Bordonava A, Rodriguez Alfredo E , Gabe E, Gallardo P: Factibility of transluminal coronary angioplasty in acute myocardial infarction. XIV Congress Arg Soc Cardiol, Sept 1985.Gallardo P, Rodriguez Alfredo E , Bordonava A, De la Fuente L M: Coronary occlusion during transluminal coronary angioplasty. Its management in the Hemodynamics Room. XIV Congress Arg Soc Cardiol, Sept 1985.Rodriguez Alfredo E , Wisner J, Bordonava A, Gallardo P, De la Fuente L M: Coronary thrombolysis with urokinase intracoronary vs. peripheral vein infusion results. X World Congress of Cardiology, Washington DC, September 1986.Rodriguez Alfredo E , Wisner J, Bordonava A, Ortiz R, De la Fuente L M: Clinical and angiographic correlation in acute myocardial infarction using thrombolytics. X Congress of Cardiol, Rosario, November 1986, Argentine Federation of Cardiology.Rodriguez Alfredo E , Peñalosa E, Gallardo P, Wisner J: Complex coronary angioplasties. Inmediate results and late follow-up. X Congress of Cardiol, Rosario, November 1986, Argentine Federation of Cardiology. Albarracín F, Rodriguez Alfredo E , Martínez F, Uribe A, Massano C: Analysis of the principal complications and mortality in a six year follow-up for aortic and mitral replacement using duramadre or Starr Edwars valves. X Congress of Cardiol, Santa Fe, November 1986, Argentine Federation of Cardiology.Londero H, Picabea E, Rodriguez Alfredo E , De la Fuente L M: Value of the different indexes of ventricular function taken from the ventriculogram in the detection of located small alterations in ventricular contraction. X Congress of Cardiol, Santa Fe, November 1986. Argentine Federation of Cardiology.Wisner J, Rodriguez Alfredo E , Gallardo P, De la Fuente L M: Transluminal aortic valvuloplasty in the aortic valvular stenosis of adults. Arg J Cardiol 55, 4: 11-213, 1987.Sarmiento R A, Gigena G, Gonzalez Mora R, Rodriguez Alfredo E , Wisner J, Esper J R, Richitelli M A: Clinical prediction of the physiopathological mechanism in acute myocardial infarction, effect of fibrinolysis. Arg J Cardiol 55, 4: 106-203, 1987.Ayrad O, Cragnolino D, Meretta A, Masoli O, Rodriguez Alfredo E , Pérez Baliño N, De la Fuente L M: A study of the left ventricular function in symptomatic and asymptomatic patients after transluminal coronary angioplasty. Arg J Cardiol 55, 4: 97-185, 1987. Ayrad O, Cragnolino D, Meretta A, Masoli O, Rodriguez Alfredo E , Pérez Baliño N, De la Fuente L M: Transluminal coronary angioplasty. Clinical follow-up and study of the left ventricular function. Arg J Cardiol 55, 4: 87-165, 1987.Peñaloza E, Rodriguez Alfredo E , Traverso Dighero, Gallardo P, De la Fuente L M: Complex coronary angioplasties, inmediate resultand follow-up. Arg J Cardiol 55, 4: 48-87, 1987.Sarubi A, Rodriguez Alfredo E , Barrero C, Nul D, Miceli M, Turri D: Clinical prediction of the physiopathologic mechanism in acute myocardial infarction. Natural evolution. Arg J Cardiol 55, 4: 107-206, 1987.Gallardo P, Rodriguez Alfredo E , Risau G, Wisner J, De la Fuente L M: Incidence of restenosis post angioplasty in the ostial obstruction of the anterior descendent artery. Arg J Cardiol 55, 4: 88-167, 1987.Rodriguez Alfredo E , Ruda Vega M, Tacchi H, De la Fuente L M: Antecedents of the intermediate syndrome in the progressive angina. VI Congress of Cardiol, 1978.Rodriguez Alfredo E , Tacchi H, Ruda Vega M, Gadda C, De la Fuente L M: Antecedents in the angina post acute infarction. VI Congress of Cardiol, 1978.Rodriguez Alfredo E . (Chairman). Quantification by Digital Angiography of the degree of residual obstruction in arteries responsible of acute myocardial infarction. XVI Congress Arg Cardiol, 1989.Rodriguez Alfredo E , Santaera O, Risau G, Díaz R, Sosa Liprandi M I, Pérez-Baliño N, Lugones M. Early repeat coronary angiography predicts late restenosis after successful coronary angioplasty. Eur Heart J 86: 438, 1990.Rodriguez Alfredo E . (Chairman). Transluminal Coronary Angioplasty in Anterior Descendent Arteria, as the only vaso Angiographic variables and its correlation with inmediate results. XVII Congress Arg of Cardiol, 1990.Rodriguez Alfredo E . (Chairman). Use of endocoronary phrostesis (stent) in transluminal coronary angioplasty. XVII Congress Arg of Cardiol, 1990.Rodriguez Alfredo E . (Chairman). Peripheral and coronary atherectomy by catheter. A recent experience. XVII Congress Arg of Cardiol, 1990.Rodriguez Alfredo E . et al. (Chairman). Clinical status and its angiographic correlation in the late follow-up of patients post successful angioplasty. XVII Congress Arg of Cardiol, 1990.Rodriguez Alfredo E , Santaera O, Risau G, Fernández M, Szenjfeld M, Larribau M, Cristino A, Lugones M, Quantitative assessment of unstable plaque using videodensitometric and geometric digital analysis. Eur Heart J 156: 888, 1991.Rodriguez Alfredo E ., et al. (Chairman). Transluminal Coronary Angioplasty. Use of the technic with double system of metallic guía with or without baloon. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E ., et al. (Chairman). Intracoronary stent. Early results and follow-up. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E ., et al. (Chairman). Peripheral rotative atherectomy with Kensey catheter. Initial experience. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E ., et al. (Chairman). Percutaneous mitral valvuloplasty. Inmediate results. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E ., et al. (Chairman). Digital angiographic quantification post successful angioplasty. A non co Inventional analysis. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E ., et al. (Chairman). Serial endiomiocardic biopsy in monitoring patients after cardiac transplantation. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E ., et al. (Chairman). Transluminal coronary angioplasty in patients with previous revascularization surgery. XVIII Congress Arg of Cardiol, 1991.Rodriguez Alfredo E , Santaera O, Szenjfeld M: In hospital outcome in one vessel coronary angioplasty. Related to unstable patient or type plaque characteristic. XV Interamerican Congress of Cardiology, Orlando, USA, 1992.Rodriguez Alfredo E , Boullón F, Paviotti C, Díaz R, Sosa Liprandi M I, Pérez-Baliño N, Palacios I: Argentine randomized trial coronary angioplasty vs. by pass surgery in multiple vessel disease (ERACI). In hospital results and one year follow-up. 41st Annual Scientific Session, American College of Cardiology, J Am Coll. Cardiol; 704-706: 24A, 1992.Díaz R, Paolasso E, Piegas L S, Sandoya E, Szwarcer E, Rodriguez Alfredo E , Vercamen E, van der Werf F: The Ridogrel vs. Aspirin Patency Trial (RAPT). Early Study Group, Buenos Aires, Argentine and University of Leuven, Belgium. Circulation, 1992, I, 642, 2556.Rodriguez Alfredo E , Santaera O, Sosa Liprandi M I, Perez Baliño N, Mele E, Palacios I: Coronary angioplasty in patients with multiple obstructions. Analysis of the results in the randomized group (ERACI) and the effect of the type of revascularization in the late clinical follow-up. XIX Congress Arg Soc Cardiol, Sept 1992.Fernandez M, Santaera O, Szejnfeld M, Larribau M, Cristino A, Rodriguez Alfredo E : Inmediate results and in hospital evolution after coronary angioplasty. Are they related to clinical or angiographic characteristics? XIX Congress Arg Soc Cardiol, Sept 1992.Sosa Liprandi M I, Rodriguez Alfredo E , Boullón F, Mele E, Santaera O, Perez Baliño N, Palacios I: An Argentine randomized study angioplasty vs.surgery (ERACI): late follow-up, and free from coronary events. XIX Congress Arg Soc Cardiol, Sept 1992.Cristino A, Santaera O, Fernandez M, Szejnfeld M, Larribau M, Rodriguez Alfredo E : Transluminal angioplasty on the subclavian artery: Inmediate results and late follow-up. XIX Congress Arg of Cardiol, Sept 1992.Rodriguez Alfredo E , Larribau M, Santaera O, Sarmiento R, Pérez Baliño N, Newell J, Palacios I: Early decreases in minimal lumen diameter after PTCA are associated with higher incidence of late restenosis. 42º Annual Scientific Session, American College of Cardiology. J Am Coll Cardiol: 851-889, 1993.Rodriguez Alfredo E , Cristino A, Fernández M, Larribau M, Nadal F, Santaera O: Non-surgical revascularization in brachiocefalic vessels: Role of percutaneous transluminal angioplasty. Eur Heart J: 14-1428, 1993.Quintana L, Ruiz N, Schiro G, Quintana M, Cáceres C, Mele E, Rodriguez Alfredo E , Pérez Baliño N. Changes in Ventricular Function after direct PTCA. Arg Soc Cardiology. Bariloche, Mayo, 1993.Pérez Baliño N, Masoli O, Huria M, Traverso S, Méndez R, Mele E, Rodriguez Alfredo E . Myocardial variability with thalium 201 24 hours after. Cost/benefit analysis. Arg Soc Cardiology. Mar del Plata, Mayo, 1993.Sosa Liprandi M I, Andreu E, Boullón F, Ahualli P, Rodriguez Alfredo E , Pérez Baliño N: Spontaneus improvement of left ventricular function in patients with dilated myocardial disease. Arg Soc Cardiology. Mar del Plata, Mayo, 1993.Pérez Baliño N, Masoli O, Iturria M, Meretta A, Quintana L, Peyregne E, Mele E, Rodriguez Alfredo E : Prognostic value of the Anrinone test in patients with ischemic myocardiopathy. XX Argentine Congress of Cardiology. 61 – Supp 2 – 2, 1993 Arg. J of Cardiol.Haiek C, Sosa Liprandi M I, Pérez Baliño N, Rodriguez Alfredo E , Mele E: Clinical criteria o reperfusion correlates with the angiography results after primary PTCA. XX Argentine Congress of Cardiology. Supp 2 – 10, 1993. Arg. J of Cardiol.Pérez Baliño N, Masoli O, Iturria M, Vogel D, Mele E, Rodriguez Alfredo E : Spect in unstable and stable angina. XX Argentine Congress of Cardiology. Arg. J of Cardiol 61 – 2, 38 – 1993.Pérez Baliño N, Masoli O, Iturria M, Haiek C, Vogel D, Mele E, Rodriguez Alfredo E : Viability detected with Spect in patients with chronic asymptomatic infarction. Argentine J of Cardiol, 61 – 2, 102, 1993.Cristino A, Santaera O, Larribau M, Fernández M, Rodriguez Alfredo E : Initial experience with percutaneous transluminal angioplasty in carotid arteries. Argentine J of Cardiol, 61 – 2: 136, 1993. Larribau M, Santaera O, Fernández M, Cristino A, Rojas R, Pérez Baliño N, Rodriguez Alfredo E : Comparison in late angiographic patency between patients treated with streptokinase end/or direct PTCA. Argentine J of Cardiol, 61 – 2, 143, 1993.Rojas R, Santaera O, Larribau M, Cristino A, Pérez Baliño N, Rodriguez Alfredo E : Improvement of left ventricular function after primary PTCA. Argentine J of Cardiol, 61 – 2, 166, 1993.Rojas R, Santaera O, Larribau M, Fernández M, Mele E, Pérez Baliño N, Rodriguez Alfredo E : Primary PTCA in acute myocardial infarction. In hospital results in a consecutive serie. Argentine J of Cardiol, 61 – 2: 168, 1993.Pérez Baliño N, Masoli O, Rodriguez Alfredo E , Iturria M, Meretta A, Cragnolino D, Perrone S, Mele E, Palacios I: Left ventricular ejection fraction response to Anrinone Bolus. A challenge in order to identifying patients with ischemic cardiomyopathy and reversible chronic left ventricular dysfunction. 43rd Annual Scientific Session, American College of Cardiology, Georgia, Atlanta, USA, J Am Coll Cardiol, 1994.Rodriguez Alfredo E , Santaera O, Larribau M, Fernández M, Riccitelli M, Pérez Baliño N, Palacios I, Roubin G: Rational use of coronary stenting to prevent restenosis: a randomized study in lesions with early minimal lumen diameter loss after PTCA (66 pts). 43º Annual Scientific Session, American College of Cardiology. J Am Coll Cardiol 118A: 730-736, 1994.Rodriguez Alfredo E , Ahualli P, Pérez Baliño N, Mele E, Paviotti C, Sosa Liprandi M I, Palacios I: Argentine randomized trial of percutaneous transluminal coronary angioplasty vs. coronary artery bypass surgery in multivessel disease (ERACI): Late cost and three year follow-up results. 43rd Annual Scientific Session, American College of Cardiology. J Am Coll Cardiol; 469A: 829-2, 1994.Rodriguez Alfredo E , Santaera O, Larribau M, Fernández M, Sarmiento R, Palacios I, Roubin G. Coronary stents reduce restenosis in lesion with early MLD loss after PTCA (88 pts). Eur Heart J, 535: 2938, 1994.Rodriguez Alfredo E , Fernández M, Peyregne E. et al. Non Surgical Revascularization of Carotid Arteries. Role of PTA. Journal of Am Coll Cardiol 1995, 796-1.P. Moreno, J. Fallon, V. Bernardi, Rodriguez Alfredo E , et al. Early luminal deterioration after successful coronary bellow angioplasty: Insights into the mechanisms form coronary tissue analysis. J Am Coll. Cardiol., February 1996; Special Issue. Abstracts 922-47.Rodriguez Alfredo E , E. Mele, E. Peyregne, et al. Three year follow up of the Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery by pass surgery in multivessel disease (ERACI). J Am Coll Cardiol; 1996, 27: 1178-84.E. Mele, Rodriguez Alfredo E , E Peyregne, et al. Final follow up of Argentine randomized trial coronary angioplasty vs bypass surgery in multivessel disease (ERACI): Clinical outcome and lost analysis. Circulation, October 1996 (Abstract)Rodriguez Alfredo E , O Santaera, M Fernández et al. Optimal Coronary Angioplasty vs stent (OCBAS). Protocol presentation of a randomized trial (Optimal Coronary Balloon Angioplasty vs Stent) XV Congreso Nacional de Cardiología FAC, Mayo 1996 V. Bernardi, O Santaera, M Fernández, C Mauvecin, A Cristino, R Sapino, A Delacasa, Rodriguez Alfredo E . Hospitalary results of intracoronary stent without anticoagulation and ultrasound. XV Congreso Nacional de Cardiología FAC, Mayo 1996.Rodriguez Alfredo E , Ayala F, M Fernández et al. Coronary stent utility during primary angioplasty: Protocol presentation of a randomized study (Gianturco Roubin II In acute myocardial infarction). XV Congreso Nacional de Cardiología FAC, Mayo 1996 O. Santaera, M Fernández, C Mauvecin, V Bernardi, A Cristino, A Delacasa, Rodriguez Alfredo E . Transluminal Angioplasty with or without stent in treatment of extracraneal carotideal lesions. Primera experiencia latinoamericana. XV Congreso Nacional de Cardiología FAC, Mayo 1996M. Fernández, O Santaera, C Mauvecin, V Bernadi, A Cristino, R Sapino, A Delacasa Rodriguez Alfredo E . Occlusion of secundary branches during stent colocation: Incidency and clinical correlate. XV Congreso Nacional de Cardiología FAC, Mayo 1996 V. Bernardi, Rodriguez Alfredo E , P Moreno et al. Precocious loss of minimal luminal diametre after baloon angioplasty: mecanism’s study since coronary cell tissue analysis. XV Congreso Nacional de Cardiología FAC, Mayo 1996Rodriguez Alfredo E , L Grinfeld, J Navia et al. Randomized Argentine study, angioplasty versus surgery in multiple vessels disease: Presentation of protocol of fase II: Stent verus surgery of revascularization (ERACI II)Rodriguez Alfredo E , F Ayala, C Pardiñas et al. Optimal balloon angioplasty vs stent (OCBAS): Preliminary results of a randomized trial. J Am Coll. Cardiol, March 1997.Rodriguez Alfredo E , V Bernardi, M Fernández et al. Coronary stents improved results during coronary angioplasty in acute myocardial infarction: preliminary results of a randomized controlled study (GRAMI Trial). J Am Coll. Cardiol., March 1997Rodriguez Alfredo E , V Bernardi, M Fernández et al. Coronary stents improved hospital outcome in patients undergoing angioplasty in acute myocardial infarction: Results of a randomized multicenter study (GRAMI trial). European Society of Cardiology. Stockholm, August 1997.Rodriguez Alfredo E , V Bernardi, O Santaera et al. Coronary stents improved hospital outcome in patients undergoing PTCA in acute myocardial infarction: Results of a randomized multicenter study (GRAMI trial). Transcatheter Cardiovascular Therapeutics. Washington September 1997. Am J Cardiol 1997; 80Rodriguez Alfredo E , V. Bernardi, F Ayala, et al . Optimal coronary balloon angioplasty versus stent (OCBAS): Angiographic long term follow up results of a randomized trial. American Heart Association. Orlando, November 1997 V. Bernardi, O Santaera, C Mauvecin, A Cristino, D Vogel, Rodriguez Alfredo E . Angioplasty with baloon verus stent in thrombotic lesions. II Congreso Latinoamericano de Cardiología Intervencionista (SOLACI) Julio 1997V Bernardi, F Ayala, E Marchand, C Pardiñas, O Santaera, C Mauvecin, I Palacios, Rodriguez Alfredo E . Optimal Angioplasty versus stent (OCBAS). Angiographic Follow up of a randomized trial. II Congreso Latinoamericano de Cardiologia Intervencionista (SOLACI), July 1997.V Bernardi , O Santaera, M Fernández, C Mauvecin, E Mele, J Martinez, G Roubin, I Palacios, J Ambrose, Rodriguez Alfredo E . Coronary Stent in acute miocardial Infarction.(GRAMI). Hospitalary Results in randomized trial. II Congreso Latinoamericano de Cardiologia Intervencionista (SOLACI) Julio 1997V Bernardi, O Santaera, C Mauvecin, A Cristino, D Vogel, M Russo, Rodriguez Alfredo E . Coronary Stents in unprotected lesions of left main artery. II Congreso Latinoamericano de Cardiología Intervencionista (SOLACI) Julio 1997Santaera, V Bernardi, C Mauvecin, M Fernández, M Garrido, Rodriguez Alfredo E , GRAMI: Inmediate and hospitalary results in a randomized group: Stent vs baloon in IAM. Comparison between single vessel and multiple vessels disease. II Congreso Latinoamericano de Cardiología Intervencionista (SOLACI) Julio 1997V. Bernardi, O Santaera, C Mauvecin, N López Cabanillas, A Cristino, J Martinez, M Russo, D Vogel, Rodriguez Alfredo E . Angioplasty with baloon versus stent in thrombotic lesions. Congreso de la Sociedad Argentina de Cardiología, Octubre 1997.V Bernardi, F Ayala, E Marchand, J Martinez , O Santaera, C Mauvecin, D Vogel, I Palacios, Rodriguez Alfredo E . Optimal angioplasty versus stent (OCBAS). Angiografic Follow up of a randomized trial. Congreso de la Sociedad Argentina de Cardiología, Octubre 1997.V Bernardi , O Santaera, M Fernández, C Mauvecin, E Mele, J Martinez, G Roubin, I Palacios, J Ambrose, Rodriguez Alfredo E . Coronary Stent in acute miocardial Infarction (GRAMI) Hospitalary Results in randomized study. Congreso de la Sociedad Argentina de Cardiología, Octubre 1997. V. Bernardi, O Santaera, C Mauvecin, A Cristino, D Vogel, M Russo, Rodriguez Alfredo E . Coronary Stents in unprotected lesions of left main. Congreso de la Sociedad Argentina de Cardiología, Octubre 1997.R Bonilla, V Bernardi, C Mauvecin, M Fernández, M Garrido, O Santaera, Rodriguez Alfredo E , GRAMI: Innmediate and hospitalary results in a randomized study: Stent vs baloon in IAM. Comparison between single vessel and multiple vessel disease. Congreso de la Sociedad Argentina de Cardiología, Octubre 1997 S Saavedra, O Santaera, C Fernández, C Mauvecin, V Bernardi, J Martinez, L Grinfeld. Rodriguez Alfredo E . Abciximab use in intervencionial coronary procedures in pacients with acute isquemic syndromes. Congreso de la Sociedad Argentina de Cardiología, Octubre 1997Rodriguez Alfredo E , V Bernardi, O santaera, et al. Coronary stents improve outcome in Acute Myocardial Infarction: Immediate and Long term results of the GRAMI trial. American College of Cardiology, Atlanta March 1998 Santaera, V Bernardi, C Mauvecin, J Martinez, D Vogel, C Fernández, A Kaminker, Rodriguez Alfredo E . In hospital results in patients treated with stents in acute myocardial infarction: Can we improve clinical and angiographic outcome with Abciximab? American College of Cardiology, Atlanta March 1998 Santaera, V Bernardi, C Fernández, A Cristino, A Delacasa, S Saavedra, M Rodriguez Alemparte, C Mauvecin, Rodriguez Alfredo E . Percutanous Transluminal Carotid Angioplasty. In hospital and follow up results. Am J Cardiol 1998, 82; Suppl 7 A: 10 SAbciximab plus stenting are associated with lower complications in Acute Coronary Syndromes. V. Bernardi, O Santaera, C Mauvecin, C Fernández Pereira, J Martínez, Rodriguez Alfredo E . Am J Cardiol 1998, 82; Suppl 7 A: 10SUnprotected Left Main Angioplasty in Stent Era. Acute and Long Term Outcome. C Mauvecin, V Bernardi, O Santaera, C Fernández Pereira, S Saavedra, M Rodriguez Alemparte, J Martínez, Rodriguez Alfredo E . Am J Cardiol 1998; Suppl 7 A: 10 SV Bernardi, S Saavedra, O Santaera, C Mauvecin, D Gonzalez, C Fernández Pereira, Rodriguez Alfredo E . Acute Coronary Syndrome: Stent vs. Baloon. XXV Congreso Argentino de Cardiología. Octubre 1998.M Russo Felsen, V Bernardi, C Mauvecin, S Saavedra, M Rodriguez Alemparte, S Ostolaza, O Santaera, E González Toledo, J Martínez, Rodriguez Alfredo E . XXV Congreso Argentino de Cardiología. Octubre 1998. V Bernardi, O Santaera, C Mauvecin, J Martínez, C Fernández Pereira, S Saavedra, Rodriguez Alfredo E . Coronary stents in unprotected left main artery lesions. XXV Congreso Argentino de Cardiología. Octubre 1998.O Santaera, V Bernardi, C Mauvecin, C Fernández, S Saavedra, M Rodriguez Alemparte, J Martínez, Rodriguez Alfredo E . Evaluation of an antithrombotic and intervencionist combined strategy (Abciximab and stent) in acute corinary syndromes. XXV Congreso Argentino de Cardiología. Revista Argentina de Cardiología, Vol. 66, Supl. IV, Pág. 124, Octubre 1998.M Rodriguez Alemparte, O Santaera, S Saavedra, V Bernardi, C Mauvecin, C Fernández Pereira, D González, Rodriguez Alfredo E . Does the diagnosed angiography followed by angioplasty modify the intrahospitalary results? XXV Congreso Argentino de Cardiología. Revista Argentina de Cardiología, Vol. 66. Supl. IV, Pág. 143, Octubre 1998.Pilot Study with Oral Rapamycin in Patients Undergoing Stenting in Coronary Arteries: Buenos Aires Experience (ORAR Trial).Rodriguez Alfredo E , Maximo J. Rodriguez Alemparte, Carlos Fernandez Pereira, Cesar F. Vigo, Claudio Llaurado, Miguel Russo Felsen, Oberdan Andrin, Jorge L. Martinez, Otamendi Hospital, Buenos Aires, Argentina.Prospective Multicenter International Randomized Trial Comparing Infarct Artery Stenting Alone With Infarct Artery Stenting plus Abciximab in Acute Myocardial Infarction: Principal Report of the Abciximab and Carbostent Evaluation (ACE) Trial. David Antoniucci, Rodriguez Alfredo E , Albrecht Hempel, Angela Migliorini, Guido Parodi, Antonio Bartorelli, Antonio Colombo, Giovanni M. Santoro, Guia Moschi, Renato Valenti, Leonardo Bolognese, Maurizio Trapani, Cesar F. Vigo, Careggi Hospital, Florence, Italy, Otamendi Hospital, Buenos Aires, ArgentinaUnprotected Left Main Angioplasty in Stent Era. Acute and Long Term Outcome. V Bernardi, C Mauvecin, O Santaera, C Fernández Pereira, P. Boskis, E Mele, J Martínez, Rodriguez Alfredo E . American College of Cardiology 1999Argentine Randomized Study Optimal Coronary Balloon Angioplasty and Stenting vs. Coronary Bypass Sugery in Multiple Vessel Disease (ERACI II): In hospital and 30 days results. Rodriguez Alfredo E , L Grinfeld, N Perez Baliño, J Navia, J Baldi, R Grinfeld, M Garrido. D Vogel, A Delacasa, E Mele, J Martinez, R Oliveri, I Palacios, W O’Neil. 47th Scientific Session , American College of Cardiology 1999.Cost Effectivenesst Analysis Between Percutaneous Coronary Interventions vs. Coronary Bypass Surgery in Multiple Vessels Disease: Long Term Follow Up Results of the Randomized Study (ERACI II)” Rodriguez Alfredo E V. Bernardi, J. Baldi, J. Navia, L. Grinfeld, C. Mauvecin, C. Fernandez, M. Rodriguez Alemparte, I. Palacios, W. O´Neill. XIX South American Congress of Cardiology. XXXIII Venezuela Congress of Cardiology. Caracas, Venezuela .Jun 1999.Argentine Randomized Study Coronary Angioplasty with Stenting vs. Coronary Bypass Surgery in Multiple Vessels Disease (ERACI II): Acute and Mid Term Outcome. Rodriguez Alfredo E O Santaera, L Grinfeld, V Bernardi, J Baldi,J Navia, D Guastavino, M Martínez Peralta, I Palacios, W O’Neill on behalf of ERACI II Investigators, XXI European Society .Cardiology August 1999.Cost Benefit Analysis Between Percutaneous Coronary Interventions vs. Coronary Bypass Surgery in Multiple Vessels Disease: Long Term Follow Up Results of the Randomized Study (ERACI II)” Rodriguez Alfredo E V. Bernardi, J. Baldi, J. Navia, L. Grinfeld, C. Mauvecin, D. Vogel. R. Oliveri, I. Palacios, W. O´Neill. Transcatheter Cardiovascular Therapeutics The XXI Annual Symposium, , Washington USA. September 1999.Randomized Trial of Balloon Angioplasty Versus Stenting for the Treatment of Long Coronary Lesions. Rodriguez Alfredo E , Alexandre Abizaid, Rafael Moguel, William Torres, Carlos Fernandez, Vinicius Vaz, Maximo Rodriguez, Rodolfo Staico, Fausto Feres, Eduardo Sousa, Igor F. Palacios, Massachusetts General Hospital, Boston.Final Angiographic and Clinical Results of the Latin America Small Vessel Randomized Study (LASMAL Trial). Rodriguez Alfredo E , Maximo J. Rodriguez Alemparte, Carlos Fernandez Pereira, Alberto Sampaolesi, Ronaldo Loures Bueno, Carlos Rubio, Cesar F. Vigo, Angel Obregon Santos, on behalf of Biodivysio Investigators, Otamendi Hospital, Buenos Aires, Argentina, Adrogue Medical Institute, Buenos Aires, Argentina.Argentine Randomized Study Coronary Angioplasty with Stents vs. Coronary Bypass Sugery in Multiple Vessel Disease (ERACI II): One Year Follow Up Results. Rodriguez Alfredo E , V. Bernardi, J. Navia,J. Baldi, L. Grinfeld, J Martinez, D. Vogel, R Grinfeld, A Delacasa, M Garrido, R. Oliveri, E Mele,I. Palacios, W. O´Neill. on behalf of ERACI II Investigators. J. Am.Coll Cardiol, March 2000.Cost Effectiveness Analysis Between Percutaneous Coronary Interventions vs. Coronary Bypass Surgery in Multiple Vessels Disease: Long Term Follow Up Results of the Randomized Study (ERACI II), Rodriguez Alfredo E V. Bernardi, J. Baldi, J. Navia, L. Grinfeld, C. Mauvecin, D. Vogel. R. Oliveri, I. Palacios, W. O´Neill, J. Am.Coll Cardiol, March 2000.Percutaneous Transluminal Coronary revascularization vs. Coronary Bypass Surgery In Patients with Multiple Vessel Disease and Proximal left Anterior Descending Artery Stenosis: Results From the ERACI II Study. Rodriguez Alfredo E , S. Saavedra, C. Fernández, M. Rodriguez Alemparte, J. Baldi, L. Grinfeld, R Grinfeld, J Martinez, M. Russo Felsen,I. Palacios, W. O´Neill on behalf of ERACI II Investigators. J. Am.Coll Cardiol, March 2000.Diabetic Patients With Multivessel Disease Treated with Percutaneous Coronary Revascularization Had Similar Outcome Than Those Treated with Surgery: One Year Follow Up Results From Two Argentine Randomized Studies (ERACI – ERACI II). C. Fernandez Pereira, V Bernardi, J Martinez, J. Baldi, D. Vogel, L. Grinfeld, M. Russo Felsen, C. Mauvecin, E. Mele, I. Palacios, A. Rodriguez. J. Am.Coll Cardiol, March 2000.Patients With Three Or More Vessel Disease Treated with Percutaneous Interventions Achieved Similar Safety Long Term Outcome To Those Treated With Conventional Coronary Bypass Surgery: One Year Follow Up Results From the ERACI II Study. Rodriguez Alfredo E M. Rodriguez Alemparte, V. Bernardi, J. Baldi J. Navia, A Delacasa, D. Vogel). C. Fernandez Pereira, I. Palacios, W. O´Neill. J. Am.Coll Cardiol, March 2001.Three Years Follow-up Results of Argentine Randomized Study Coronary Angioplasty With Stenting Versus Bypass Surgery In Patients With Multiple Vessels Disease (ERACI II). Rodriguez Alfredo E M. Rodriguez Alemparte, J. Baldi, J. Navia, J. Martinez, D. Vogel, A. Delacasa, V. Bernardi, C. Fernández Pereira, I. Palacios, W. O´Neill. Otamendi Hospital, Buenos Aires, Argentina, William Beaumont Hospital, Royal Oak, Michigan. J. Am. Coll Cardiol, March 2002.Latin America Small Vessel Randomized Study (LASMAL): In Hospital and 30 Days Results. Rodriguez Alfredo E M. Rodriguez Alemparte, V. Bernardi, A.F. Vigo, A. Sampaolesi, R. Da Rocha Loures Bueno, O. Andrin, A. Obregón Santos. SCA&I, May 2002.Coronary stenting versus coronary bypass surgery in patients with multiple vessel desease and significant proximal LAD stenosis: results from the ERACI II study. Rodriguez Alfredo E M. Rodriguez Alemparte, J. Baldi, J. Navia, A Delacasa, D Vogel, R Oliveri, C Fernández Pereira,V. Bernardi, W O´Neill, I F Palacios, on behalf of the ERACI II Investigators. Herat 2003; 89:184-188Percutaneous Treatment of Acute Myocardial Infarction in Latin America” Results from the Latin Americ Society of Interventional Cardiology (SOLACI), presentado al XIV TH World Congress of Cardiology, Sydney, Australia, Mayo 5-9/2002 . JACC (Suppl B), 39:99B .Elective angioplasty of unprotected left main. Resultados hospitalarios y al seguimiento. Andrin O, Vigo C, Fernandez Pereira C, Mauvecin C, Bernardi V, Serra W, Rodrigueaz Alemparte M, Rodriguez Alfredo E , Sanatorio Otamendi, Buenos Aires XXX Congress Arg Soc Cardiol, 2002.Estudio Latinoamericano de Angioplastia Coronaria en pequeños vasos (LASMAL). Hospitalary results in 30 days Follow-up, Rodriguez Alemparte M, Fernandez Pereira C, , Bernardi V, Vigo , Sampaolesi A, da Richa Loures Bueno R, Obregon Santos, Rodriguez Alfredo E , Sanatorio Otamendi, Buenos Aires XXIX Congress Arg Soc Cardiol, 2002Randomized Argentine Study of Stent Coronary Angioplasty vs Conventional Surgery in Patients with Multiple Vessel Coronary Disease. Fernandez Pereira C, Bernardi V , Mauvecin C, Rodrigueaz Alemparte M, Andrin o, Vigo C, Serra W, Rodriguez Alfredo E , Sanatorio Otamendi, Buenos Aires xxix Congress Arg Soc Cardiol, 2002.Primary Stent Angioplasty with and without abcximab (ACE TRIAL): Hospitalary results in a 30 days period Follow-up. Rodriguez Alfredo E , Rodriguez Alemparte M, Russo M, Bartorelli A, Colombo A, Hempel A, Antoniucci D, Sanatorio Otamendi, Buenos Aires xxix Congress Arg Soc Cardiol, 2002.RandomizedTrial of Balloon Angioplasty Versus Stenting for the treatment of Long Coronary Lesions. . Rodriguez Alfredo E A. Abizaid, R. Moguel, W. Torres, C. Fernández, V. Vaz,M. Rodríguez,R. Staico, F. Feres, J. E. M. Sousa, I. Palacios, Massachusetts General Hospital, Boston ,MA. JACC March 2003, 1052- 184.Final Angiographic and clinical Results of the Latin America Small Vessel Randomized Study (LASMAL Trial) Rodriguez Alfredo E M. Rodriguez Alemparte, C. Fernández Pereira, A. Sampaolesi, R. Loures Bueno, C. Rubio, C. F Vigo, A. Obregon Santos, on behalf of Biodyvisio Investigators. Otamendi Hospital, Buenos Aires, Argentina, Adrogue medical Institute, Buenos Aires, Argentina. JACC March 2003, 1076- 185Pilot Study with Oral Rapamycin in Patients Undergoing Stenting in Coronary Arteries: Buenos Aires Experience (ORAR Trial) Rodriguez Alfredo E M. Rodriguez Alemparte, C. Fernández Pereira, C. F Vigo, C. Llaurado, M. Russo Felsen, O. Andrin, J.L Martinez. Otamendi Hospital, Buenos Aires, Argentina, JACC March 2003, 879- 3Pilot Study of Oral Rapamycin to Prevent Restenosis in Patients Undergoing Coronary Stent Therapy: Argetnina Single Center Study (ORAR Trial) Rodriguez Alfredo E M. Rodriguez Alemparte, C F Vigo, C Fernández Pereira C. Llaurado, M. Russo Felsen, R. Virmani, J. Ambrose Otamendi Hospital, Buenos Aires, Argentina, J Invas Cardiol October 2003 Prospective Multicenter International Randomized Trial Comparing Infarct Artery Stenting Alone with Infarct Artery Stenting plus Abciximab in Acute Myocardial Infarction: Principal Report of the Abciximab and Carbostent Evaluation (ACE) Trial. D. Antoniucci, Rodriguez Alfredo E A. Hempel, A. Migliorini, G. Parodi, A. L Bartorelli, A. Colombo, G. M Santoro, G. Moschi, R. Valenti, L. Bolognese, M. Trapani, C. F Vigo, Careggi Hospital, Florence ,Italy, Otamendi Hospital, Buenos Aires ,Argentina JACC March 2003, 1025-165Comparison of Impact of Emergency Percutneous Revascularization on Outcome in Patients > 75 years to those < 75 years with acute Myocardial Infarction Complicated by Cardiogenic Shock. JACC June 2003. Latin America Small Vessel Randomized Study in Diabetic Patients (LASMAL II): Clinical and Angiographic Follow Up Data. Rodriguez Alfredo E M. Rodriguez Alemparte, C Fernández Pereira, V Bernardi, C F Vigo, C Llaurado, A Sampaolessi, R Loures Bueno, The LASMAL. Otamendi Hospital, Buenos Aires, Argentina, Clinica IMA, Adrogue, Argentina. JACC March 2004, 1081- 48Oral Rapamycin in Patients Undergoing Coronary Stent Therapy: Final Results of the ORAR Study (Oral Rapamycin in Argetnina). Rodriguez Alfredo E M J. Rodriguez Alemparte, C Fernández Pereira, C F Vigo, C Llaurado, M Russo Felsen, A Pocovi, D Vetcher,. Otamendi Hospital, Buenos Aires, Argentina, Argentine Society for Cardiac Intervention, Buenos Aires, Argentina. JACC March 2004, 878- 2Five Year Follow-up of Argentine Randomized Study of Coronary Stents vs Coronary Bypass Surgery in MultipleVessels Diasease. Rodriguez Alfredo E , M Rodriguez Alemparte, J Baldi, C Fernández Pereira, C F Vigo, A de la Casa, I Palacios, W O’Neill. Invasive Cardilogy Otamendi Hospital, Buenos Aires, Argentina, 1 Cardiac Unit Massachussets General Hospital Boston United States of America, 2 Cardiology William Beaumont Michigan United States of America. , European Society 2004Dose Response Study of Oral Rapamycin in Prevention of Angiographic Restenosis: Result of ORAR Pilot Trial. Rodriguez Alfredo E , M Rodriguez Alemparte, C F Vigo, C Fernández Pereira, Rodriguez Alfredo E Granillo, J Guiroy, J. Mieres. Invasive Cardiology Otamendi Hospital, Buenos Aires, Argentina, European Society 2004.Abciximab-supported infarct artery stent implantation for acute myocardial infarction and long-term survival. A randomized trial comparing infarct artery stenting plus abciximab. D Antoniucci, A Migliorini, G Parodi, R Valenti, AE Rodriguez, A Hempel, G Memisha, GM Santoro. European Society, 2004.Efficacy and Tolerability of Oral Rapamacin to Prevent Restenosis after Coronary Stent Implantation: The prospective, Randomized ORAR II Study. Rodriguez Alfredo E M Rodriguez Alemparte, C Fernández Pereira, A Pocoví, J Tronge, G Kaluza, A Raizner, G W Stone, Otamendi Hospital, Buenos Aires Argentina, Columbia University Medical Center, New York,NY, JACC FEBRUARY 2005, 839- 5 WISDOM high – risk Subgroups: 12 Month Outcomeswith the Slow – releas. Polymer – based, Paclitaxel eluting Taxus Stent. A Abizaid, C Chan, T Teng – Lim,U Kaul, T Patel, H C Tan, N Sinha, J Lopez, E Gaxiola, S Ramesh, A Rodriguez, M Adamian, WISDOM Investigtors. Instituto de Cardiologia dante Pazzanese, Sao Paulo Brazil.- JACC February 2005, 866- 3Long Term clinical and angiographic follow up of oral rapamycin in patients undergoing coronary bare stent theraphy: Results of the randomized ORAR II trial.-. Rodriguez Alfredo E Juan Granada, M Rodriguez Alemparte, Juan Delgado, C F Vigo, C Fernández Pereira, A Pocoví, Rodriguez Alfredo E Granillo, D. Schultz, A Raizner, I Palacios, W O´neill, G Kaluza, G Stone. Poster Congress 2005 – ESC (European Society of Cardilogy) September StockholmCoronary Stent thrombosis in current drug eluting stent era: Insights from ERACI III Trial. Carlos Fernandez Pereira MD, A. Rodríguez MD, Juan Guiroy MD, Juan Mieres MD, Carlos Rodriguez Pagani, C F Vigo MD, M Rodriguez Alemparte MD, Daniel Berrocal MD, Liliana Grinfeld MD, Igor Palacios, TCT 2005 Washington.Cost Efectiveness in PatientsTreated with drug eluting stents vs bare metal stent ans oral rapamycin in hospital and one year follow up “Carlos Fernandez Pereira MD, Juan Mieres, C F Vigo, M Rodriguez Alemparte, Angeles Rodriguez, Valeria Curotto, A. Rodríguez MD. TCT 2005 WashingtonMultiple vessel stenting in drug eluting stent era: one year follow up of the ERACI III study. Rodriguez Alfredo E L Grinfeld, C Fernandez-Pereira, J Mieres, D berrocal, C F Vigo, W O´Neill, I Palacios. Poster Congress 2005 – ESC (European Society of Cardilogy) September Stockholm.Cost Effectiveness of two Diferent Strategies of revascu Stent Era: Hospital and Long Term Follow Up Results.- C Fernandez Pereira,Juan Mieres, M Rodriguez Alemparte, C F Vigo, AM Rodriguez Granillo, V Curotto, Rodriguez Alfredo E – ESC (European Society of Cardilogy) 2006.Percutaneous Coronary Intervention with Bare Metal Stents and Oral Sirolimus has Comparable Safety and Efficacy to treatment with Drug Eluting Stents but with Significant Cost Saving: Long Term Follow up results from the Randomized, Controlled ORAR III (Oral Rapamicyn in Argentina) Study. Rodriguez Alfredo E Andrew Maree, Sonia Tarragona, Carlos Fernandez-Pereira, Alfredo M Rodriguez-Granillo, Gaston A Rodriguez-Granillo, Omar Santaera, Juan Mieres, Neville Kukreja, David Antoniucci, Igor Palacios, Patrick Serruys. American Heart Association, Circulation 2008;118.5-1051.Percutaneous Coronary Intervention with Bare Metal Stents and Oral Sirolimus has Comparable Safety and Efficacy to treatment with Drug Eluting Stents but with Significant lower cost: thirtyone months cost saving and clinical events analysis, from the Randomyzed, controlled ORAR III (Oral Rapamycin in Argentina) Study. Carlos Fernandez-Pereira, Bibiana Rubilar, Juan Mieres, Carlos Rodriguez-Pagani, Omar Santaera, Alfredo M Rodriguez-Granillo, David Antoniucci, Igor Palacios, Patrick W Serruys, Rodriguez Alfredo E American Heart Association, Scientific sessions November 2009.Impact of Diabetic Population in the Long term Outcome of Patients with Multiple vessel Sisease Treated with Drug Eluting Stents, Bare Metal Stents or Coronary Bypass Surgery: Insights from Final Five Years Follow up Results of ERACI III Study. Rodriguez Alfredo E Liliana Grinfeld, Daniel Berrocal, Juan Mieres, Alfredo M Rodriguez-Granillo, Carlos Fernandez-Pereira, Valeria Curotto, Andrew Maree, William O´Neill, Igor F Palacios. American College of Cardiology (ACC), March 2010.Comparison of a Paclitaxel Eluting Stent with Biodegradable Polymer and Glycolix Coating versus Bare Metal Stent Design: First Presentation of 9 Months Clinical and Angiographic Outcome of the Ramdomized, Multicenter and Controlled EUCATAX Trial (NCT00825279). Rodriguez Alfredo E Federico C Vigo, Alejandro Delacasa, Victor Bernardi, Marcelo Bettinotti, Omar Santaera, Valeria Curotto, Carlos Fernandez-Pereira, Bibiana Rubilar, Juana Mieres, David Antoniucci, Igor F Palacios. American College of Cardiology (ACC), march 2010. | ||||||
-
CV RODRIGUEZ ALFREDO E , M.D., Ph.D., FACC., FSCAI
Read More -
La Cardiología Intervencionista que viví en mis 41 años de práctica (1980-2021).
Alfredo E Rodriguez MD ,PhD, FACC,FSCAI
Debo agradecer la excelente oportunidad que nos brinda el Colegio Argentino de Cardioangiologos Intervencionistas (CACI) a los que fuimos miembros fundadores del Colegio y practicamos la especialidad hace ya más de 40 años.
A través de estas páginas tratare de resumir lo que considero los elementos más importantes vividos por todos nosotros desde el inicio de la especialidad y que además estuvo muy ligado a lo que sucedió y sucede en el mundo con esta fascinante y cambiante especialidad. En el año 1980, estando como jefe de Residentes del servicio de Cardiología/Hemodinamia/Cirugía Cardiovascular del Sanatorio Guemes entonces Fundación Favaloro, cuyos Directores eran los Drs Rene G. Favaloro y Luis de la Fuente, comenzamos hacer nuestras primeras armas en angioplastia periférica, de arterias femorales y también de arterias renales, no teniendo todavía la capacidad operativa y técnica para comenzar este tratamiento en arterias coronarias.
Tres años antes habían dejado el servicio quienes fueron lideres de ese momento los Drs Marcelo Ruda Vega y Hugo Londero y estaban como staff los Drs Jorge Leguizamón y Eduardo Picabea
En ese entonces hacia casi tres años que el Dr Andreas Gruntzig presentaba sus primeros casos realizados en Zúrich en 1977 en un meeting del American Heart Association.
También por ese entonces, en 1979 Peter Rentrop mostraba los beneficios de la trombólisis intracoronaria con estreptoquinasa para reperfundir pacientes en las primeras horas de un infarto agudo de miocardio.
La cardiología intervencionista comenzaba a nacer.
Es justamente en el año 1980, precisamente el día 3 de octubre, día de mi cumpleaños, que tuve la oportunidad de realizar mi primera experiencia en terapéutica por catéter en cardiopatía isquémica en un paciente con infarto agudo supra ST.
El paciente tenía 12 horas de un post operatorio de bypass venoso “side to side” a las arterias Descendente Anterior y Diagonal que presentaba un infarto extenso anterolateral con compromiso hemodinámico.
El Dr Favaloro llama a Hemodinamia, hablo con él y le propongo la posibilidad de infundir trombolíticos en el sitio de la posible oclusión es decir el bypass Aorto coronario con vena safena.
El conocido hematólogo Raúl Altman, trabajaba asociado estrechamente con el Dr Favaloro y además contaba con Uroquinasa para tratamientos específicos.
Con estos elementos cateterizamos selectivamente el bypass ocluido y le infundí Uroquinasa in situ durante una hora lográndose la reperfusión de la arteria Diagonal y todo el tercio proximal y medio de la Descendente Anterior con flujo TIMI 3 y completa estabilización hemodinamica.
Recuerdo con mucha alegría que el Dr Favaloro me llamo y me dijo: “Rodriguez este es tu mejor regalo de cumpleaños”
Este caso lo presente en un congreso Sudamericano de Cardiología y dos años después se publicó junto con otro caso realizado posteriormente por otro staff del servicio de Hemodinamia en la revista del American Heart Association como Case Report.
Increíble que a pesar de haberlo realizado yo personalmente como se dice en la jerga quirúrgica “ de piel a piel” fui excluido deliberadamente de la publicación sin mi conocimiento y aprovechando mi ausencia debido a numerosos viajes realizados a USA durante los años 1981/82.
En ese año 1980 el Dr Richard Myler pionero de angioplastia en USA da conferencias en el Sanatorio Güemes invitado por el Dr Favaloro.
Ahí surge la posibilidad de viajar a su Servicio, cosa que lo hice en Enero de 1981 estadia que se prolongó por tres meses. Anos mas tarde, fue el Dr Myler que me presento y posibilito mi acceso como Fellow del American College of Cardiology.
En ese lapso, también tuve la oportunidad de visitar al Dr John Simpson en la Universidad de Stanford que estrenaba un nuevo sistema de catéteres y guías metálicas móviles para angioplastia coronaria, sistema que se denominó “steerable”.
En abril estando ya en Argentina, comenzamos a realizar las primeras angioplastias coronarias en el Sanatorio Guemes.
La angioplastia en Europa y USA estaba en plena ebullición, con varios pioneros además de Gruntzig en Suiza, uno de los mas importantes el Dr Geofrey Hartzler en Kansas, USA, sin duda el nombre más importante en angioplastia en infarto agudo de miocardio que falleció lamentablemente en forma muy temprana.
Hartzler en 1982 introduce el método de hacer angioplastia primaria sin trombólisis previa lo que se llama angioplastia directa.
La angioplastia en infarto agudo de miocardio era por entonces muy controversial, con resultados contradictorios y la mayoría se hacía después de la infusión de trombolíticos.
A fines de 1981 un año después de haber realizado la trombólisis intracoronaria antes descripta, tuve la oportunidad de efectuar una angioplastia post trombólisis en un paciente con infarto agudo supra ST de pared inferior por oclusión de la arteria Coronaria Derecha, primero reperfundí la misma con infusión intracoronaria de Uroquinasa y luego se practicó angioplastia por balón exitosa.
Este caso fue publicado a principios del año 1982 en la Revista de la SAC (1) a mi conocimiento fue el primer caso de angioplastia coronaria post trombólisis en el infarto agudo de miocardio realizada en América Latina y probablemente solo un grupo alemán fue contemporáneo que en ese mismo año 1982 publicaron dos casos en la revista Circulation.
En toda esta década de 1980 se produce el boom de nuestra especialidad en todo el mundo occidental, tanto USA como Europa muestran la explosión de nuestra especialidad, la angioplastia coronaria con balón (POBA) es también a fines del 80 acompañada con otros “devices” como aterotomo direccional, rota ablación, balón de dilatación e infusión prolongada etc hacen su aparición y nos permiten realizar angioplastias mas complejas que las inicialmente seleccionada por Gruentzig.
Es en esos momentos, mediados de la década del 80 que iniciamos nuestro propio grupo de trabajo clínico en 1986 pero también de investigación clínica el Centro de Estudios en Cardiología Intervencionista (CECI) que persiste hasta el presente.
En esos momentos comenzaban a surgir con fuerza experiencias limitadas pero muy prometedoras en el uso del stent metálico (BMS) para prevenir las oclusiones coronarias durante la angioplastia con balón, y los nombres de Sigwart, Puel, Marco, Serruys, Roubin y de Palmaz comienzan a escucharse muy frecuentemente en todos los ámbitos científicos de nuestra especialidad.
# Décadas 1990/2000/2010 o el ascenso vertiginoso de la angioplastia como método terapéutico del paciente coronario agudo y crónico.
Estas fueron en mi opinión las décadas “doradas” de nuestra especialidad.
La primera 1990/2000 mostro la consolidación del uso del stent metálico durante las angioplastias para tratar las complicaciones agudas como así también la reestenosis coronaria post POBA evitando el “recoil agudo y crónico” post angioplastia con balón que era por entonces la causa principal de reestenosis post balón. El uso del BMS lo introducen en USA los Drs Roubin y Palmaz con sus dispositivos balón expandible, el primer BMS aprobado por la FDA en USA para tratar complicaciones agudas fue el de Gianturco-Roubin seguido poco tiempo después por el Palmaz-Schatz.
El uso del stent se introduce en todas las condiciones clínicas inclusive el infarto agudo de miocardio y en lesiones coronarias muy complejas.
En esta década,1990/2000, se publican los primeros estudios aleatorizados de angioplastia coronaria con POBA versus cirugía coronaria directa (CABG) en pacientes con obstrucciones simples, de múltiples vasos, mayoritariamente con enfermedad coronaria crónica y en pacientes diabéticos . Posteriormente, estas mismas comparaciones se harían con el uso de BMS. También es la época de los estudios aleatorizados comparativos en el infarto agudo de miocardio entre angioplastia versus trombólisis y luego angioplastia con POBA versus angioplastia con stent .
En la década siguiente ,2000/2010, dos importantes metaanálisis demostraron que a largo plazo la angioplastia en pacientes con enfermedad multi vaso tiene la misma sobrevida y sobrevida libre de infarto comparativamente a la CABG excluyendo los pacientes diabéticos. En estos análisis la sobrevida en pacientes jóvenes mostraba una clara ventaja a favor de la angioplastia, hecho entendible pero que se demostró por primera vez en este metaanálisis . La única diferencia a favor del CABG eran la mayor frecuencia de nuevos requerimientos de revascularización con angioplastia.
Lamentablemente, estos hallazgos se publicaron,2008/2009, en el preciso momento del auge de los DES, por lo tanto, estos resultados fueron pasados por alto.
El uso del BMS si bien había minimizado las complicaciones agudas de la angioplastia su uso producía una reestenosis del mismo por hiperplasia fibrointimal producto de una cicatrización exagerada que producía nuevas reintervenciones del vaso tratado durante los primeros 8-10 meses post implante en un 15% /20% .
La introducción de drogas inmunosupresoras en el stent que se liberaban durante el primer mes post implante en el endotelio arterial producía una reducción significativa de esa hiperplasia y una importante reducción de nuevas revascularizaciones. Con esta combinación evitábamos tanto el recoil agudo como también la hiperplasia fibrointimal.
Esto es el inicio de los stents liberadores de fármacos (DES) que revolucionaron y aun hoy en algunos foros de discusión, no en el mío propio, siguen revolucionando nuestra especialidad. Los nombres de Antonio Colombo, Eberhard Grube, Martin Leon, Patrick W. Serruys y Greg Stone es en gran medida, a ellos a quien se les debe este salto tecnológico con la introducción de los stents liberadores de fármacos (DES). En este punto, nuestro colega Eduardo Sousa y su grupo en Brasil jugaron también un rol relevante. Sin embargo, nuestro país nuevamente no estuvo ausente en este desarrollo de los DES, y uno de los estudios observacionales en su uso fue realizado en Argentina por el Dr Luis de la Fuente y a pesar de que sus hallazgos no fueron refrendados por un largo estudio multinacional aleatorizado europeo, que se debió finalizar prematuramente por exceso de complicaciones trombóticas de este diseño de DES, este estudio piloto fue pionero en ese momento.
En los últimos 15 años son múltiples los grupos de investigadores argentinos que participaron en estudios con el uso de DES.
La reducción significativa de nuevas revascularizaciones post DES nos hicieron abrir expectativas demasiado optimistas con el uso de este: “el fin de la reestenosis era el fin también de la CABG” según se escuchaba con el resultado de los primeros estudios aleatorizados con DES. En el apartado siguiente veremos cuán lejos estamos hoy de esas predicciones.
Este exceso de optimismo en realidad estaba basado en reducción de puntos finales completamente secundarios y no clínicos como la reducción del llamado “late loss” que nunca pudo ser correlacionado con eventos duros post angioplastia.
.
# Década 2010/2021 Del ascenso vertiginoso como indicación de revascularización hasta la realidad actual.
En este punto voy a ser muy directo, pero también muy crítico y mis opiniones deben tomarse también desde el punto de vista personal.
Con el advenimiento del uso DES en la práctica clínica, múltiples trabajos aleatorizados comparativos entre la angioplastia con DES versus la CABG se han realizado a la fecha, hasta el presente podemos contabilizar 8 estudios tres en lesiones de tronco no protegido, uno en múltiples vasos y tronco y los cuatro restantes en múltiples vasos incluyendo pacientes diabéticos.
Todos excepto uno, invariablemente mostraron aumento no solo de los procedimientos de revascularización que fue un acompañante natural de la angioplastia desde su inicio y que no debería preocuparnos, sino que también en 7 de ellos se observó un incremento de mortalidad y/o infarto espontaneo de miocardio que es el más preocupante y que se asocia a mortalidad.
La mayor complejidad de los pacientes tratados podría ser una de las explicaciones de estos hallazgos, pero seguramente no la única de hecho diversos metaanálisis han demostrado que independientemente de la complejidad anatómica la CABG tuvo menor incidencia de eventos duros como infarto de miocardio y en algunos estudios también de mortalidad.
Este cambio en los parámetros de seguridad en estudios comparativos con cirugía ya se había observado en el largo registro americano del ASCERT con 190 mil pacientes tratados con CABG y PCI (78% DES1) durante los años 2004 a 2008 en 64 sitios de USA y donde en pacientes >64 años hubo significativa reducción de la mortalidad con CABG incluso en grupos de riesgo angiográfico y clínico bajo (no diabéticos y lesión de dos vasos) y que motivo que nosotros escribiésemos un artículo de revisión en el año 2012, donde ya llamábamos la atención sobre estos hallazgos. Esta referencia esta dentro de los artículos sugeridos para leer.
Si bien es totalmente cierto que los DES redujeron notablemente la incidencia de nuevas revascularizaciones la mortalidad no se modificó cuando comparamos con los viejos diseños de DES y/o incluso los BMS.
El uso de DES tuvo con los primeros diseños cuatro limitaciones algunas de ellas entrelazadas:
1-Stent trombosis precoz, tardía y muy tardía.
2-Mala aposición tardía del DES. Estas dos eran muchas veces correlativas
3- Neo-aterosclerosis precoz inmediatamente después del ano del implante.
4- Disfunción endotelial tanto en el stent como en los segmentos proximales y distales al implante.
Stent trombosis y mala aposición dependían fundamentalmente del polímero y hoy podemos decir que es un tema completamente solucionado.
Sin embargo, las dos restantes neo-aterosclerosis precoz y disfunción endotelial dependería principalmente de la acción local de la droga inmunosupresora. La primera es causa de infarto espontaneo no relacionado a un nuevo procedimiento fenómeno que estamos observando casi invariablemente en todos los estudios aleatorizados comparativos con la CABG. La disfunción endotelial también esta asociado a efectos adversos cardiacos, pero últimamente también con efectos adversos no cardiacos incluyendo aumento de frecuencia de tumores sólidos. No hay que olvidarse que el endotelio es un órgano con múltiples funciones como: “vasodilation, thrombolysis, platelet disagreggation, antioxidant, antiinflammation, antiproliferation”.La pérdida de su función normal es decir la disfunción endotelial podría producir los efectos contrarios: “vasocontriction, thrombosis, platelet agreggation, oxidant activity, inflammation and growth factors”. En este punto es muy importante que los cardiólogos intervencionistas definamos costo/beneficio entre supresión de restenosis / disfunción endotelial y las consecuencias de esta última.
Sobre este tema recomiendo leer los manuscritos referenciados abajo por Toya y col y Abdul-Jawad Altisent y col, dentro de las ultimas referencias de este capítulo.
Llama la atención varias observaciones relacionadas con mortalidad no cardiaca en pacientes tratados con angioplastia en el momento actual que no estaban presentes en observaciones previas y esto debería ser motivo de cuidadoso análisis en estudios aleatorizados apropiadamente realizados, así como en registros prospectivos. Este aumento de mortalidad no cardiaca se observó en estudios aleatorizados entre DES y CABG, pero no entre BMS y CABG, en registros de PCI y CABG muy conocidos y también entre comparaciones de diferentes diseños de DES. Recomiendo leer el metaanálisis de Gaudino, los 5 años del EXCEL, el estudio de Pilgrim a 5 años de un”ultrathin DES”, el registro CREDO-Kyoto de angioplastias y CABG todos referenciados abajo así como también el abstract del ISCHEMIA trial publicado en Circulation en Noviembre del año pasado y del European Heart Journal este ano. La publicación de este ultimo motivo un comentario Editorial nuestro que esta publicado en el European Heart Journal Open en Febrero de este ano y en donde en una Tabla describimos todos los estudios que reportaron aumento de muerte no-cardiaca con DES en seguimiento a largo plazo, a estos deberemos incluir los hallazgos del estudio ISCHEMIA que es realmente muy preocupante.
Como sabemos los estudios randomizados con tamaño suficiente tienen el poder de homogenizar basalmente las poblaciones por lo cual la explicación del aumento de eventos adversos inesperados en poblaciones aleatorizadas grandes deberá buscarse en otros escenarios.
Denominar a hallazgos adversos, muerte no cardiaca, como fruto de la casualidad me parece una actitud temeraria y fuera de toda lógica que obviamente le hace mucho daño a nuestra especialidad.
Solo una sincera discusión de todos estos hallazgos entre los lideres de opinión juntamente con la Industria podremos salir de este laberinto que nos encontramos ahora donde cada nuevo estudio aleatorizado tanto con CABG o con tratamiento médico nos lleva una nueva frustración.
Últimamente inclusive la introducción de métodos de diagnóstico funcional de lesiones coronarias como el FFR o iFR para guiar la PCI no han sido exitosos en demostrar reducción de eventos post implante de DES tanto en pacientes con infarto agudo o pacientes electivos, recomiendo leer los resultados publicados este ano de estudios randomizados al respecto entre ellos el FUTURE, FAME 3 y el de Puymirat E et al en infarto agudo de miocardio todos referenciados abajo entre las lecturas sugeridas. Los resultados negativos de estos estudios con FFR nos demuestran que rápido los cardiólogos intervencionistas adoptamos técnicas y nuevos “devices” generando muchas veces falsas expectativas por una sobreestimación apresurada de los beneficios.
Las nuevas guías de tratamiento recientemente elaboradas en conjunto con cardiólogos clínicos que en mi criterio fueron benévolas con nosotros, muestra que contrario a lo que se pregonaba 15 años atrás y a pesar del advenimiento de los más modernos diseños de DES, la cirugía coronaria esta más viva que nunca. De hecho, las Sociedades Americanas (USA) y Europea de Cirugía Torácica y Cardiovascular no endorsaron dichas guías de tratamiento.
# Creación del Centro de Estudios en Cardiología Intervencionista (CECI).
En el año 1986 junto con colegas y amigos formamos un grupo de trabajo independiente primero en el Sanatorio Anchorena para luego movernos al Sanatorio Otamendi desde 1993 hasta el presente.
Durante todos estos anos no hay palabras para describir el apoyo a todas nuestras tareas asistenciales y científicas desarrolladas en el Otamendi, vaya pues mi agradecimiento a sus autoridades pasadas los Drs Jose A. De All por quien entre a trabajar en dicha Institución y al Dr Jorge Aufiero así como también a las autoridades actuales.
Durante todos estos años, pasaron por el Servicio a formarse en la práctica de nuestra especialidad muchísimos cardiólogos, muchos de ellos hoy Jefes de Servicio en lugares referentes de nuestro país así como destacados miembros de sociedades científicas que no los podría enumerar por la cantidad, tanto de nuestro país como de América Latina. Por el servicio pasaron residentes de casi todas las nacionalidades de la región de habla española y portuguesa desde Paraguay, Chile, Brasil, Bolivia, Perú, Uruguay, Ecuador, Venezuela, Colombia, Panamá y República Dominicana que luego siguieron conectados con nosotros realizando muchas veces trabajos de investigación en conjunto.
En el año 1988, creamos un departamento de investigación clínica independiente que, si bien no fue concebido como una CRO, donde en Argentina hay varias, algunas de ellas de excelencia, nos permitió realizar en forma ordenada una multiplicidad de protocolos de investigación en nuestro país al principio en forma individual para posteriormente realizar estudios multicéntricos incluyendo multinacionales.
De igual manera realizamos desde 1993 cursos en vivo la mayoría de las veces en forma colaborativa con SAC y CACI los cursos CECI donde han participado como Faculties la casi totalidad de los mayores nombres pasados y presentes de nuestra especialidad de los ultimo 30 años. Este ano, el 7 de Diciembre lo hicimos en forma virtual con la presencia de los Drs Adnan Kastrati, Ron Waksman, Peter Smits y Mario Gaudino.
Vamos a hacer el resumen de los trabajos más importantes y que creo tuvieron un rol en la práctica clínica de nuestra especialidad:
Esto comenzó con lo que fue el primer trabajo aleatorizado publicado entre angioplastia coronaria con POBA versus CABG que fue el estudio ERACI I publicado en JACC en 1993 y 1995. Años después con el advenimiento de los BMS se realizó la segunda versión de este trabajo el ERACI II que a diferencia del primero fue multicéntrico con el acompañamiento de la recordada Liliana Grinfeld en esta oportunidad. El primero y quinto año de seguimiento se publicaron en el JACC en el 2001 y 2005 ambos manuscritos se publicaron simultáneamente con el estudio ARTS de Patrick Serruys.
En el año 1993, publicamos una observación que sugería que la reestenosis post balón era mayormente producida por el “recoil “ agudo de la arteria post dilatación del balón hecho muy novedoso, nunca antes se lo había relacionado. En el modelo animal de restenosis se sabía que el daño endotelial producido por el mecanismo de la angioplastia llevaba a la reestenosis por hiperplasis fibrointimal del vaso meses más tarde, sin embargo, esto no era igual en el ser humano donde la placa aterosclerótica muchas veces es excéntrica y con comportamiento diferentes a la acción del balón de manera que aquellas lesiones que no modificaban su diámetro 24 horas después de la angioplastia con balón la incidencia de reestenosis fue muy baja. Esto fue motivo de varias publicaciones: Am J of Cardiol 1993,1995, Circulation 1995 y en JACC 1998 y tambien de discusiones académicas con lideres de la especialidad que hablaban de: “.. coronary restenosis a time related phenomenom…” por lo cual nuestras observaciones eran totalmente opuestas y fueron motivo de controversias. El tiempo nos dio la razón y Patrick Serruys termino aceptando de que el recoil agudo era un fenómeno muy importante en la fisiopatología de reestenosis post POBA, ahí empezó hablar de “stent like results post POBA” en otras palabras resultados post balón óptimos sin recoil agudo.
Fue muy grato hace 3 años atrás ver en la galería del Congreso del PCR expuesta como uno de los hitos de la angioplastia justamente el trabajo nuestro de stent en elastic recoil OCBAS trial que fue publicado en JACC 1998 conjuntamente con los estudios ERACI I y II.
En el mismo sentido, también fue muy estimulante leer en el libro sobre historia de las intervenciones cardiovasculares y cardiología intervencionista que uno de sus mayores pioneros Gary Roubin cuyo libro mencionado se titulaba “ The First Balloon-Expandable Coronary Stent an Expedition That Changed Cardiovascular Medicine” publicado en el 2015 nos incluyera junto con Julio Palmaz y Rene Favaloro como los únicos latinoamericanos en la lista de los 93 pioneros de Angioplastia e intervenciones cardiovasculares, esta referencia esta también dentro de las lecturas sugeridas.
El uso del stent en el sitio de un infarto agudo de miocardio si bien atractivo era muy polémico, nuestro grupo dado la relación con el querido Gary Roubin publicamos una corta experiencia en el uso de stent en infarto supra ST en Am J of Cardiol 1996, que nos llevó inmediatamente después hacer lo que fue el primer estudio aceptado para su publicación con stent en infarto agudo el GRAMI trial publicado en Am J of Cardiol 1998 que fue contemporáneo al estudio de David Antoniucci de hecho este se publicó dos meses antes en JACC pero el estudio nuestro había sido aceptado dos meses antes que el estudio de Florencia de manera que nosotros cronológica y académicamente estuvimos primero. Anécdotas que siempre nos contamos en las charlas familiares con mi gran amigo de Italia.
Ya entrando en el nuevo milenio, el Centro CECI participo de registros prospectivos y estudios observacionales como los relacionados a DES trombosis publicado en EuroIntervention en Febrero del 2007 ( “Late stent thrombosis the Damocles sword of DES”) un mes antes que el promocionado artículo de Camenzid y Wijns en Circulation, el registro ERACI III, que fue publicado en JACC en 2006 y en el Eur Heart J en 2007 este último trabajo fue motivo de que esta revista europea incrementase su “impact factor” de acuerdo a una carta personal que recibimos del Editor en Jefe de dicha revista.
El artículo de revisión sobre “DES late thrombosis” hubo amigos que me recomendaron no publicarlo porque podría tener reacciones adversa desde la Industria que manufacturaba los DES, a pesar de esos consejos, el trabajo fue enviado y luego de revisión aceptado y publicado en EuroIntervention. Debo decir, además, que nunca sentí reacción adversa de la Industria por esto.
Si los médicos de la carrera de especialidad del CACI se preguntan cómo pudimos desde Argentina realizar tantos estudios que se publicaran en los mayores “Journals” de habla inglesa les diría que todo se logra con trabajo y mucha honestidad en el análisis y observación de los hechos que uno está viendo. Siempre se debe estar seguro de lo que está diciendo y siempre se deberá chequear la información varias veces antes de emitir un juicio más aún si esto implica hallazgos originales fuera de lo establecido y esperado. De hecho, en el momento en que se escribían estos pensamientos, el 30 de Abril de 2022, según Research Gate los manuscritos de datos científicos publicados por nosotros como autores o co-autores merecían 26222 lecturas, 7568 fueron motivos de referencias bibliográficas y tienen 3920 puntos de interés de investigación que son los números más grandes logrados por cualquier grupo o persona individual en nuestro país en el área de cardiología intervencionista.
Las controversias con nuestros hallazgos ocurrieron en varias ocasiones con el “elastic recoil” , los estudios ERACI y con stent en infarto agudo de miocardio. En estos puntos la colaboración con Igor Palacios, Gary Roubin, John Ambrose, William O’Neill y David Antoniucci fueron muy importantes. Como dije en la ocasión de una distinción que me otorgo la Legislatura de CABA: “ los trabajos los hicimos acá en Argentina con ideas totalmente nuestras y pacientes nuestros, pero nada hubiese sido igual si nuestros amigos y colegas de USA y Europa no nos hubiesen apoyado ”.
En el estudio ERACI I, que Favaloro se enojó muchísimo cuando lo hicimos y hablo mal de los hallazgos incluyendo tratar de convencer al cirujano que había operado casi todos los pacientes de que no firmase el manuscrito una vez que estaba aprobado en el JACC, un trabajo argentino publicado en el JACC en el año 1993 tenía pocos precedentes en la cardiología de nuestro país, finalmente primo la racionalidad y el cirujano firmo el trabajo, el Dr Néstor Perez-Balino fue testigo fiel de lo que estoy relatando. Tuve, sin embargo, el gusto de que varios años después, mayo del 2000, cuando ya se había aceptado para su publicación el nuevo ERACI II, Favaloro me llamara por teléfono para felicitarme personalmente por este trabajo y con cálidos recuerdos del pasado compartido en un momento muy difícil de la Fundación y también personal de el a pocos meses antes de su fallecimiento.
En los últimos 20 años Centro CECI participo de varios estudios aleatorizados multinacionales con diversos diseños de DES y diferentes estrategias de revascularización en pacientes con infarto agudo y en pacientes crónicos.
De esta manera participamos en el abciximab en infarto agudo con un stent metálico de carbono, JESTENT trombectomía reolitica en el infarto agudo, FREEDOM, FREEDOM long term outcome DES vs CABG en pacientes diabéticos, MULTISTRATEGY sobre DES y abciximab en infarto agudo , VALENTINES con balón liberador de Paclitaxel, DEFINITION II tratamiento de bifurcaciones con DES incluyendo lesiones de tronco no protegido y últimamente MASTER DAPT comparación de estrategia antiplaquetaria con DES, todos ellos publicados varias veces en NEJM,JAMA,JACC, Circulation, Eur Heart Journal , JACC Intervention y EuroIntervention.
Igualmente, nuestra base de datos fue entregada para su análisis y control de diversos metaanálisis es así que los estudios ERACI y ERACI II se entregaron para la publicación de Pocok en Lancet 1995, Hlatky en Lancet 2009 y JACC 2012, Daemen en Circulation 2008 y Head en Lancet 2018.
De igual manera la base de datos del estudio EUCATAX fue entregada al Dr Valgimigli para su metaanálisis del Lancet 2019 y Circulation 2021.
También, basados en un registro prospectivo de múltiples vasos, es que nació el Score de ERACI como estrategia de revascularización en pacientes con enfermedad de múltiples vasos y tronco de coronaria izquierda, que fue producto mancomunado de varios centros en nuestro país y que trata de reducir el número de DES implantados siguiendo esquemas anatómicos de tamaño del vaso y grado de estenosis por angiografía, este Score fue validado tanto con el uso de DES como BMS.
He dejado para el final los trabajos relacionados a la prevención de la reestenosis por vía sistémica con drogas inmunosupresoras y/o antiinflamatorios orales post implante de un BMS.
Si bien esta estrategia en la era de la angioplastia con balón no dio resultados favorables, de hecho no los podía tener dado que la fisiopatología no era inflamatoria sino producto del recoil agudo y crónico, en la era del stent metálico desnudo todos los estudios aleatorizados hechos por nosotros y por grupos europeos con drogas inmunosupresoras como la Rapamicina y/o prednisona, Alemania, Italia, Serbia y Grecia, tuvieron resultados positivos y que fueron resumidos en un meta-análisis de base de datos individuales publicado por Kastrati en el 2014, sin embargo, nunca esta estrategia fue introducida en la práctica clínica.
Nosotros en este momento estamos haciendo un estudio aleatorizado costo efectivo entre DES de última generación versus BMS más tratamiento con colchicina por tres meses solo en el grupo BMS que todavía está en la fase de reclutamiento que esperamos terminar en los próximos meses.
Dado los resultados contradictorios y de alguna manera inesperados en el largo plazo con los DES, todavía sigo creyendo que se deben explorar todas las opciones sin descartar ninguna para lograr la mayor eficacia y seguridad a mediano y largo plazo con nuestros procedimientos percutáneos de revascularización, llámese angioplastia coronaria con DES por ejemplo en bifurcaciones incluyendo probablemente todas las lesiones de tronco no protegida por el alto riesgo que llevaría la reestenosis en ese sitio, BMS en anatomías más favorables y/ o combinación de ambas estrategias.
Nada se debe descartar para lograr el mayor beneficio a nuestros pacientes y a esta especialidad que ha desvelado nuestras vidas desde su inicio.
En la última Editor Letter que escribimos en el JAMA a principios del año 2021 le decíamos a la Editora en Jefe de la Revista que creíamos importante publicar nuestra carta porque sentíamos que: “coronary angioplasty is on the cross roads”…
Necesitamos con honestidad explicar y discutir el origen de nuestros fracasos y redefinir la técnica, los “devices” y las indicaciones de otra manera solo les quedaran a las actuales y nuevas generaciones de cardiólogos intervencionistas los nichos de pacientes con infarto agudo en curso y/o pacientes terminales con contraindicación de CABG o expectativa de vida muy corta.
Muy poco para tan rica historia!!!
Referencias descriptas en el texto y recomendadas.
#-Gruentzig AR, Senning A, Siegenthaler WE. Nonoperative dilation of coronary
artery stenosis. Percutaneous transluminal coronary angioplasty.N Eng J Med 1979;301:61-8.
#-Rentrop KP, Cohen M, Hosat ST. Thrombolytic therapy in acute myocardial infarction: review of clinical trials. Am J Cardiol. 1984 Dec 21;54(11):29E-31E
#–Hartzler GO, Rutherford BD, McConahay DR et al: Percutaneous translu-minal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J 1983; 106:965–973.
#- Rodríguez AE, Diaz R, Zuffardi E, Navarro P, de la Fuente LM. Angioplastia
transluminal percutánea coronaria. Rev Arg Cardiol 1982;50(2):78-91.
#. Sigwart U, Puel J, Mirkovich V, Joffre E, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.N Eng J Med 1987;316:701-6.
#. Serruys PW, Juilliere Y, Bertrand ME, Puel J, Rickards AF, Sigwart U. Additionalimprovement of stenosis geometry in human coronary arteries by stenting after balloon dilatation. Am J Cardiol 1988 May9;61(14):71G-76G.
#. Roubin G, Gianturco C, Brown J, Robinson K, King S. Intracoronary stenting of canine coronary arteries after percutaneous coronary angioplasty. Circulation 1986;1986:74.
#. Palmaz JC, Windeler SA, Garcia F, et al. Atherosclerotic rabbit aortas: expandable intraluminal grafts. Radiology 1986;160:723-6.
# Palmaz JC. Balloon expandable intravascular stent. Am J Roentgenol 1988;150,1263-9.
#. Roubin G, Douglas JR, Lembo NJ, Black AJ, King S. Intracoronary stenting for acute closure following percutaneous coronary angioplasty. Circulation 1988;78:407.
#. Schatz RA, Baim DS, Leon M, et al. Clinical experience with the Palmaz-Schatz coronary stent. Initial result of a multicenter study. Circulation 1991;83:148-61.
#. Roubin G, Cannon AD, Agrawal SK, et al. Intracoronary stenting for acuteand threatened closure complications after transluminal coronary angioplasty. Circulation 1992; 85:916-27.
#. Sousa JE, Costa MA, Abizaid AC, et al. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascularultrasound follow-up. Circulation 2001 Oct 23;104(17):2007-11.
#. Rensing BJ, Vos J, Smits PC, et al. Coronary restenosis elimination with a sirolimus eluting stent: first European human experience with 6-month angiographic and intravascular ultrasonic follow-up. Eur Heart J 2001;22(22):2125-30
#Serruys PW, Degertekin M, Tanabe K, et al. RAVEL Study Group. Intravascularultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 2002 Aug 13;106(7):798-803.
#. Grube E, Silber S, Hauptmann KE, et al. TAXUS I: six- and twelve-month results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation 2003 Jan 7;107(1):38-42.
#. Colombo A, Drzewiecki J, Banning A, et al. TAXUS II Study Group. Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions. Circulation 2003 Aug 19;108(7):788-94.
# de la Fuente LM, Miano J, Mrad J et al. Initial results of the Quanam drug eluting stent (QuaDS-QP-2) Registry (BARDDS) in human subjects. Catheter Cardiovasc Interv 2001;53(4):480-8.
#. Grube E, Lansky A, Hauptmann KE, et al. SCORE randomized trial. High-dose 7-hexanoyltaxol-eluting stent with polymer sleeves for coronary revascularization: one-year results from the SCORE randomized trial. J Am Coll Cardiol 2004 Oct 6;44(7):1368-72.
# Rodríguez AE, Santaera O, Larribau M, Sosa MI, Palacios IF. Early decrease in minimal luminal diameter after successful percutaneous transluminal coronary angioplasty predicts late restenosis. Am J Cardiol 1993;71: 1391-5.
#. Rodríguez AE, Santaera O, Larribau M et al. Coronary stenting decreases restenosis in lesions with early loss in luminal diameter 24 hours after successful PTCA. Circulation 1995;91:1397-402.
# Rodríguez A, Ayala F, Bernardi V, Santaera O, Marchand E, Pardiñas C, Mauvecin C, Vogel D, Harrell LC, Palacios IF. Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results. J Am Coll Cardiol 1998 Nov;32(5):1351-7.
#. Fischman DL, Leon MB, Baim D, et al. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496-501.
# Serruys PW, de Jaegere P, Kiemeneij F et al, for the BenestentStudy Group. A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994;331:489-95.
#. * Rodríguez A, Boullon F, Pérez Baliño N, Paviotti C, Sosa Liprandi MI, Palacios IF. Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI): in-hospital results and 1-year follow-up. J Am Coll Cardiol 1993;22:1060-7.
#. Hampton JR, Handerson RA, Julian DG, et al. Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial. Lancet 1993;343:573-80.
#. King SB III, Lembo NJ, Weintraub WS, et al., for the Emory Angioplasty Surgery Trial (EAST). A randomized trial comparing coronary angioplasty with coronary artery bypass surgery. N Engl J Med 1994;331:1044-50.
#. Hamm CW, Reimers J, Ischinger T, Rupprecht HJ, Berger J, Bleifeld W, for the German Angioplasty Bypass Surgery Investigation. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomaticm ultivessel coronary disease. N Engl J Med 1994;331:1037-43.
#. Rodríguez AE, Bernardi V, Navia J et al. Argentine Randomized Study: Coronary Angioplasty with Stenting versus Coronary Bypass Surgery in Patients with Multiple Vessel Disease (ERACI II): 30 days results and on year follow-up results. J Am Coll Cardiol 2001;3:51-8.
#. Serruys PW, Unger F. Sousa JE, et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multi-vessel disease. N Engl J Med 2001;344:1117-24.
#. SoS Investigators Coronary Artery Bypass Surgery versus percutaneous coronary intervention with stent implantation in patients with multi-vessel coronary artery disease (the Stent or Surgery trial): a randomized controlled trial. Lancet 2002;360:965-70.
#. Hueb W, Soares P, Gersh B, et al. The Medicine, Angioplasty, or Surgery Study (MASS II trial): a randomized controlled clinical trial of three therapeutic strategies for multi-vessel coronary artery disease. J Am Coll Cardiol 2004;43:1743-51.
#. Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. N Engl J Med 1999; 341:1949-56.
#. Rodríguez AE, Fernández M, Santaera O et al. Coronary stenting in patients undergoing percutaneous transluminal coronary angioplasty during acute myocardial infarction. Am J Cardiol 1996 Apr 1;77(9):685-9.
#. Rodríguez AE, Bernardi V, Fernández J et al. In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Gianturco- Roubin in Acute Myocardial Infarction. Am J Cardiol 1998 Jun 1;81(11):1286-91.
#- Antoniucci D, G.M. Santoro, L. Bolognese, R. Valenti, M. Trapani, P.F. Fazzini A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction J Am Coll Cardiol, 31 (1998), pp. 1234-1239
#. Cassese S, De Luca G, Ribichini F et al. ORAl iMmunosuppressivether apy to prevent in-Stent rEstenosiS (RAMSES) cooperation: a patient-level meta-analysis of randomized trials. Atherosclerosis 2014 Dec;237(2):410-7.
#. Hlatky MA, Boothroyd DB, Bravata DM et al.Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 2009 Apr 4;373(9670):1190-7.
#. Rodríguez AE, Mieres J, Fernández-Pereira C et al. Coronary stent thrombosis in thecurrent drug-eluting stent era: insights from the ERACI III trial. J Am Coll Cardiol 2006 Jan 3;47(1):205-7. Epub 2005 Dec 9.
#. Rodríguez AE, Rodríguez-Granillo GA, Palacios IF. Late stent thrombosis the Damocles sword of Drug Eluting Stents. Eurointervention 2007 Feb; 2(4) 512-7.
#. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation 2007 Mar 20;115(11):1440-55; Epub 2007 Mar 7.
# Rodríguez AE, Maree AO, Mieres J et al.Late loss of early benefit from drug eluting stents when compared with bare metal stents and coronary artery bypass surgery: 3 years follow up of ERACI III registry. Eur Heart J 2007 Sep;29 (17):2118-25.
# Rodríguez AE, Fernández-Pereira C, Rodríguez-Granillo AM.Changes in the safety paradigm with percutaneous coronary interventions in the modern era: Lessons learned from the ASCERT registry.World J Cardiol. 2012 Aug 26;4(8):242-9. doi: 10.4330/wjc.v4.i8.242.
#. Dangas GD, Farkouh ME, Sleeper LA et al, FREEDOM Investigators. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM trial. J Am Coll Cardiol 2014 Sep 23;64(12):1189-97.
#. Antoniucci D, Rodríguez AE, Hempel A et al, A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction. J Am Coll Cardiol 2003 Dec 3;42(11):1879-85.
# Waksman R, Serra A, Loh JP et al. Drug-coated balloons for de novo coronary lesions: results from the Valentines II trial. EuroIntervention 2013 Sep;9(5):613-9.
# Rodríguez AE, Vigo CF, Delacasa A et al,; EUCATAX Investigators. Efficacy and safety of a double-coated paclitaxel-eluting coronary stent: the EUCATAX trial. Catheter Cardiovasc Interv 2011Feb 15;77(3):335-42.
# Zhang JJ, Ye F, Xu K, Kan J, Tao L et al Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J. 2020 Jul 14;41(27):2523-2536
# Rodriguez AE, Fernandez-Pereira C, Mieres J, Santaera O, Antoniucci D; ERACI IV investigators. Modifying angiographic syntax score according to PCI strategy: lessons learnt from ERACI IV Study.Cardiovasc Revasc Med. 2015 Oct-Nov;16(7):418-20. doi: 10.1016/j.carrev.2015.07.001
# Rodriguez AE, Fernandez-Pereira C, Mieres J, et al Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):792-794
# Rioufol G, Dérimay F, Roubille F,et al Fractional Flow Reserve to Guide Treatment of Patients With Multivessel Coronary Artery Disease.FUTURE Trial Investigators.J Am Coll Cardiol. 2021 Nov 9;78(19):1875-1885
# Fearon WF, Zimmermann FM, De Bruyne B et al Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass SurgeryN Engl J Med . 2021 Nov 4. doi: 10.1056/NEJMoa2112299. Online ahead of print.
# Puymirat E, Cayla G, Simon T et al Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction N Engl J Med. 2021 Jul 22;385(4):297-308.,
# Gaudino, M; Hameed, I; Farkouh ME et al, Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery A Meta-analysis; JAMA Intern Med. doi:10.1001/jamainternmed.2020.4748 Published online October 12, 2020.
# Rodríguez-Granillo AM, Fernández-Pereira C, Rodríguez AE.Drug-Eluting vs Bare-Metal Stents for Percutaneous Coronary Intervention. JAMA Intern Med. 2021 Jul 1;181(7):1012-1013. doi: 10.1001/jamainternmed.2021.0030.
# Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018;391:939–48.
# Stone GW, Kappetein AP, Sabik JF et al Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.EXCEL Trial Investigators. N Engl J Med. 2019 Nov 7;381(19):1820-1830
# Park DW, Ahn JM, Yun SC, et al. Ten-year outcomes of stents versus coronary artery bypass grafting for left main coronary artery disease. J Am Coll Cardiol 2018;72 Pt A:2813–22.
# Pavlovsky H, Rodriguez-Granillo AM, Rodriguez AE.Late Mortality After Drug-Eluting, Bare-Metal Stents, and Coronary Bypass Surgery in Left Main Disease. J Am Coll Cardiol. 2019 Apr 9;73(13):1737
# Holm NR, Mäkikallio T, Lindsay MM et al NOBLE investigators. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2020 Jan 18;395(10219):191-
# Daemen J, Boersma E, Flather M et al Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials. Circulation. 2008 Sep 9;118(11):1146-54.
# Flather M, Rhee JW, Boothroyd DB et al The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials.J Am Coll Cardiol. 2012 Nov 20;60(21):2150-7.
# Pilgrim T, Piccolo R, Heg D et al Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial Lancet. 2018 Sep 1;392(10149):737-746.
# Hironori H, Masafumi On, Hideyuki K, et al Impact of stent length and diameter on 10-year mortality in the SYNTAXES trial Catheter Cardiovasc Interv . 2021 Sep;98(3):E379-E387.
# Gomes WJ, Albuquerque LC, Jatene FB, Leal JCF, Rocha EAV, Almeida RMS.The transfiguration of the EXCEL trial: exceeding ethical and moral boundaries.Eur J Cardiothorac Surg. 2020 Jul 1;58(1):30-34.
# Fearon WF, Zimmermann FM, De Bruyne B et al; FAME 3 Investigators.Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. N Engl J Med. 2021 Nov 4. doi: 10.1056/NEJMoa2112299.
# Sabatine M, Bergmark B, Murphy S et al Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis Lancet. 2021 Dec 18;398(10318):2247-2257.
# Gaudino M, Hameed I, Di Franco A, Naik A, Demetres M, Biondi-Zoccai G, Bangalore S. Comparison of SYNTAX score strata effects of percutaneous and surgical revascularization trials: A meta-analysis J Thorac Cardiovasc Surg. 2021 Jun 2:S0022-5223(21)00881-3
# Piccolo R, Bonaa KH, Efthimiou O et al Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization. Coronary Stent Trialists’ (CST) Collaboration. J Am Heart Assoc. 2021 Oct 19;10(20):e018828
# Correa-Sadouet C, Rodríguez-Granillo AM, Gallardo C et al; ORCA investigators. Randomized comparison between bare-metal stent plus colchicine versus drug-eluting stent alone in prevention of clinical adverse events after percutaneous coronary intervention. Protocol Future Cardiol. 2021 Jul;17(4):539-547
# Piccolo R, Bonaa KH, Efthimiou O, et al Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.Coronary Stent Trialists’ Collaboration.Lancet. 2019 Jun 22;393(10190):2503-25
# Zhang JJ, Ye F, Xu K, Kan J et al Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J. 2020 Jul 14;41(27):2523-2536
# Mieres J, Rodríguez AE, Fernández-Pereira C, Ascarrunz-Cattoretti D.Increased incidence of serious late adverse events with drug-eluting stents when compared with coronary artery bypass surgery: a cause of concern. Future Cardiol. 2020 Nov;16(6):711-723
# Valgimigli M, Campo G, Percoco et al; Multicentre Evaluation of Single High-Dose Bolus Tirofiban vs Abciximab With Sirolimus-Eluting Stent or Bare Metal Stent in Acute Myocardial Infarction Study (MULTISTRATEGY) Investigators.JAMA. 2008 Apr 16;299(15):1788-99
# Writing Committee Members, Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines J Am Coll Cardiol. 2021 Dec 7:S0735-1097(21)06157-X
# Deftereos SG, Beerkens FJ, Shah B et alColchicine in Cardiovascular Disease: In-Depth Review. Circulation. 2022 Jan 4;145(1):61-78. doi: 10.1161/CIRCULATIONAHA.121.056171.
# Matsumura-Nakano Y , Shiomi H, Morimoto T et alComparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3) Am J Cardiol . 2021 Apr 15;145:25-36. doi: 10.1016/j.amjcard.2020.12.076.
# Toya T, Sara JD, Corban MT, Taher R et al Assessment of peripheral endothelial function predicts future risk of solid-tumor cancer Eur J Prev Cardiol. 2020 Apr;27(6):608-618.
# Abdul-Jawad Altisent,, Renier Goncalves-Ramírez L,Leticia Fernández et al Long-term Intra-coronary Structural and Vasomotor Assessment of the Absorb Bioresorbable Vascular Scaffold Am J of Cardiol . 2022 Jan 17;S0002-9149(21)01268-6. doi: 10.1016/j.amjcard.2021.12.037.
# Rajendran P, RengarajanT, Thangavel J et al The Vascular Endothelium and Human Diseases
International Journal of Biological Sciences 2013; 9(10):1057-1069
# Sidhu MS, Alexander KP, Huang Z et al Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial Originally published12 Nov 2020Circulation. 2020;142:A13030
# . Lopez-Sendon JL, Cyr DD, Mark DB et al Effects of initial invasive vs. initial conservative treatment strategies on recurrent and total cardiovascular events in the ISCHEMIA trial. Eur Heart J 2022;43:148–149.
# Rodriguez AE,Fernandez-Pereira C, Mieres J and A.Matias Rodriguez-Granillo Is non cardiac death increased with an initial invasive revascularization strategy? Commentary on the ISCHEMIA trial
European Heart Journal Open (2022) 00, 1–2 https://doi.org/10.1093/ehjopen/oeac012
My interventional cardiology practice over the last 41 years (1980-2021)
La Cardiología Intervencionista que viví en mis 41 años de práctica
I wish to thank the Argentine College of interventional Cardioangiologists (CACI) for giving me the extraordinary opportunity of becoming a founding member of the College and being able to practice this medical specialty for the past 40 years. Also, I wish to extend this appreciation to the mentors behind this idea, Dr. David Vetcher, and Dr. Marcelo Ruda-Vega.
In the following pages I will try to sum up what I think are the most important experiences lived by my colleagues and I since the beginning of this medical specialty including all that has been going on in this changing and fascinating specialty. Back in 1980, I was the Cardiology/Hemodynamics/Cardiovascular Surgery unit chief resident of Sanatorio Güemes, the then called Favaloro Foundation led by directors Dr. Rene G. Favaloro, and Dr. Luis de la Fuente at the time. It was then that we came up with our first tools to perform peripheral angioplasties of both femoral and renal arteries, still without the operative and technical capabilities to start this therapy in the coronary arteries.
Almost three years had gone by since Dr. Andreas Gruntzig had presented the first cases treated in Zurich, Switzerland back in 1977 in a meeting held by the American Heart Association.
Also, by then, in 1979, Dr, Peter Rentrop had already demonstrated the benefits of intracoronary thrombolysis with streptokinase for the reperfusion patients within the first few hours after an acute myocardial infarction.
Interventional cardiology as we know it was taking off.
It was precisely on October 3, 1980—my birthday by the way—that I had my first therapeutic experience using a catheter to treat the ischemic heart disease of a patient with an ST-segment elevation myocardial infarction.
The patient had sustained a 12-hour postoperative period following a side-to-side anastomosis of venous coronary artery bypass grafts to the left anterior descending coronary and diagonal arteries that showed signs of an extensive anterolateral infarction with hemodynamic compromise.
Dr. Favaloro called the cath lab. I talked to him and suggested the possibility of infusing thrombolytic drugs in the potential occlusion site, in other words, use the saphenous vein to perform the coronary artery bypass grafting.
The famous hematologist Dr. Raúl Altman, a collaborator of Dr. Favaloro, had urokinase available because he often used it for specific treatments.
With these elements we selectively catheterized the occluding bypass, proceeded with the 1-hour in-situ infusion of urokinase, and achieved the reperfusion of the diagonal artery and the entire proximal and middle third of the left anterior descending coronary artery resulting in TIMI grade-3 flow followed by complete hemodynamic stabilization.
I gladly remember Dr. Favaloro called me and told me: «Rodriguez this is the best birthday present you’re getting this year».
I presented the case at a South American congress of cardiology, and two years later it was published as a case report in the Journal of the American Heart Association with another case performed by a different member of the Hemodynamics staff unit.
Despite I personally performed this procedure skin to skin—as we say in our day-to-day medical jargon—I was deliberately excluded from the publication without my knowledge and while on one of my numerous trips to the United States during 1981 and 1982.
Back in 1980, Dr Richard Myler, an angioplasty pioneer in the United States, was giving lectures in Sanatorio Güemes as a guest of Dr. Favaloro. The opportunity was ripe for me to join his team, which I did in January 1981 for three months. Years later, Dr. Myler introduced and inducted me as a fellow of the American College of Cardiology.
At that time, I also had the opportunity of visiting Dr. John Simpson from Stanford University who was practicing with a new steerable system of catheters and moveable core metal guidewires to perform coronary angioplasties. Back in Argentina, in April, we started performing the first coronary angioplasties at Sanatorio Güemes.
Angioplasty in Europe and the United States was on the rise with pioneers like Dr. Andreas Gruntzig from Switzerland, and one of the most notorious of all, Dr. Geoffrey Hartzler from Kansas, United States who pioneered the field of myocardial infarction angioplasty. He is one of the greatest ever, there is no doubt about that. Dr. Hartzler was, unfortunately, gone before his time, but in 1982 he introduced the method to perform primary angioplasties without previous thrombolysis (a method called direct angioplasty).
At the time, acute myocardial infarction angioplasty was very controversial with conflicting results. Also, most angioplasties were being performed after the infusion of thrombolytic drugs.
At the end of 1981, one year after having performed the aforementioned intracoronary thrombolysis, I had the opportunity to perform an angioplasty after thrombolysis on a patient with an inferior wall ST-segment elevation myocardial infarction due to right coronary artery occlusion. The first thing I did was coronary artery reperfusion with the intracoronary infusion of urokinase and then perform the balloon angioplasty. The procedure was a success.
The case was published at the beginning of 1982 in the Argentine Journal of Cardiology. To my knowledge, this was the first case of coronary angioplasty after thrombolysis ever performed in Latin America in the acute myocardial infarction setting. Probably, only a German team had performed the same procedure that same year of 1982 publishing the case in Circulation.
During the 1980s our specialty skyrockets in the entire Western world both in the United States and Europe. Also, the late 1980s see the birth of plain old balloon angioplasty (POBA) and new devices like directional coronary atherectomy, rotablation, balloon dilatation catheters, and prolonged infusions, etc. allowing us to develop more complex angioplasties than the one initially performed by Dr. Gruentzig.
It wasn’t until the mid-1980s (1986) that we created our own clinical research working group, the Cardiovascular Research Center (CECI) based on Buenos Aires, Argentina. A research center that still stands today.
At that time, the first limited but very promising experiences with bare metal stents (BMS) to prevent coronary occlusions during balloon angioplasty were beginning to take shape. Names like Dr. Sigwart, Dr. Puel, Dr. Marco, Dr. Serruys, Dr. Roubin, and Dr. Palmaz started to make a difference in all scientific settings of our specialty.
# Decades of 1990/2000/2010. The dramatic ascent of coronary angioplasty as therapeutic procedure for the management of acute and chronic coronary patients.
In my humble opinion, these were the golden decades of our medical specialty.
The first decade of 1990/2000 witnessed a consolidation in the use of bare metal stents (BMS) during angioplasty to treat acute complications and coronary restenosis after POBA to avoid chronic and acute recoil after balloon angioplasty. At the time, this was the leading cause of restenosis after this procedure. The use of BMS was first introduced in the United States by Dr. Roubin and Dr. Palmaz with their balloon-expandable stents. Dr. Gianturco-Roubin’s was the first BMS approved by the FDA in the United States to treat acute complications followed shortly after by Palmaz-Schatz’s stents .
Stents eventually would be used in all clinical conditions including the acute myocardial infarction setting and very complex coronary lesions.
Also, this decade witnesses the publication of the first randomized clinical trials on coronary angioplasty with POBA vs coronary artery bypass graft (CABG) in patients with simple obstructions of multiple vessels, most of them with chronic coronary artery disease, also in diabetic patients. Shortly after these same comparisons would be made with the use of BMS . This is also the time when the first comparative randomized trials on acute myocardial infarctions treated with angioplasty vs thrombolysis are published followed by studies on angioplasty with POBA vs angioplasty with stenting .
During this decade two landmark meta-analyses confirmed that, in the long run, the angioplasty in patients with multivessel disease has the same survival and infarction-free survival rates compared to CABG excluding diabetic patients. In these analyses the survival rate of young patients showed a clear advantage towards the angioplasty, which is comprehensible, but was confirmed in this meta-analysis for the first time. The only difference in favor of CABG was the higher rate of new requirements for angioplasty revascularization.
Unfortunately, these findings were published,2008-2009, just when drug-eluting stents (DES) were on the rise, which is why these results were overlooked.
Although the use of bare metal stents minimized the occurrence of acute complications after angioplasty, it also caused in-stent restenosis due to fibrous intimal hyperplasia following the exaggerated scarring caused by new reinterventions of the target vessel within the first 8 to 10 months after stenting (> 20% rate).
The introduction of immunosuppressive drugs within the stent to be released in the arterial endothelium within the first month after stenting caused a significant reduction of this hyperplasia followed by a significant reduction of new revascularizations. Also, this combination prevented acute recoil and fibrous intimal hyperplasia.
This marked the beginning of DES that revolutionized our medical specialty. Actually, to this date, in certain discussion fora—not mine—they still revolutionize our specialty.
Esto es el inicio de los stents liberadores de fármacos (DES) que revolucionaron y aun hoy en algunos foros de discusión, no en el mío propio, siguen revolucionando nuestra especialidad. The names of Antonio Colombo, Eberhard Grube, Martin Leon, Patrick W. Serruys and Greg Stone are largely due to them this technological leap with the introduction of drug-eluting stents (DES). At this point, our colleague Eduardo Sousa and his group in Brazil also played an important role. However, our country was again not absent in this development of deS, and one of the observational studies in its use was carried out in Argentina by Dr Luis de la Fuente and despite the fact that his findings were not endorsed by a long multinational randomized European study, which had to be terminated prematurely due to excess of thrombotic complications of this DES design, this pilot study was pioneering at the time.
The significant reduction of new revascularizations reported after DES implantation brought expectations that were a little too optimistic regarding the use of stents like this. Rumor had it that «the end of restenosis would also be the end of CABG» following the early findings from the first randomized clinical trials on the use of DES. In the following section we will see how far we still are from these predictions.
This overoptimistic approach was built on reducing completely secondary and non-clinical endpoints to a minimum like minimizing the so-called “late loss” that could never be associated with the occurrence of hard endpoints after angioplasty.
# Decade of 2010/2021. The dramatic ascent of the indication of revascularization to the present day.
At this point I want to be very straightforward, but also very critical, and my opinions should also be taken from this personal point of view.
With the arrival of DES into the routine clinical practice, to this date, several randomized clinical trials including comparison groups have been conducted on angioplasty with DES vs CABG. As a matter of fact, up to 3 studies on unprotected left main coronary artery disease, 1 on multiple vessels and left main coronary artery, and the remaining 4 on multiple vessels including diabetic patients have been conducted.
From the beginning, all trials but 1 invariably showed more revascularization procedures as a natural companion of the angioplasty, which should not worry us. However, in 7 of these trials, the mortality and/or spontaneous myocardial infarction rates also went up, which is more disturbing and is associated with mortality.
The greater complexity of the patients treated could explain these findings, but it is probably not the only hypothesis. As a matter of fact, several meta-analyses proved that regardless of the anatomical complexity, the rate of hard endpoints like myocardial infarction—and in some studies, mortality—was lower with CABG.
This change in safety parameters in comparative studies with surgery had already been observed in the long American registry of ASCERT with 190 thousand patients treated with CABG and PCI (78% DES1) during the years 2004 to 2008 in 64 sites in the USA and where in patients >64 years there was a significant reduction in mortality with CABG even in groups of low angiographic and clinical risk (non-diabetic and two-vessel injury). and what a reason why we wrote a review article in 2012, where we already drew attention to these findings. This reference is among the suggested articles to read.
Although it is completely true that DES reduced significantly the rate of new revascularizations, mortality did not change when the old DES and/or even BMS designs were compared to the new ones.
With the first designs, the use of DES had 4 limitations some of which overlap:
1- Early, late, and very late stent thrombosis.
2- Poor late DES apposition. These 2 overlapped most of the times.
3- Early neo-atherosclerosis immediately after implantation (beyond 1st year).
4- Endothelial dysfunction both in the stent and in the proximal and distal segments of the implant.
Stent thrombosis and poor stent apposition were significantly associated with the polymer, but, to this date, this is not a problem anymore.
However, the 2 remaining ones—early neo-atherosclerosis and endothelial dysfunction—were mainly associated with the local action of the immunosuppressant drug. The former causes spontaneous infarctions not associated with new procedures that we have been invariably seeing in all randomized trials including comparison groups on CABG. Endothelial dysfunction is also associated with cardiac adverse events, but ultimately with non-cardiac adverse events too including a higher incidence rate of solid tumors.
It should not be forgotten that the endothelium is an organ with multiple functions such as: «vasodilation, thrombolysis, platelet disagreggation, antioxidant, antiinflammation, antiproliferation». The loss of its normal function i.e. endothelial dysfunction could produce the opposite effects: «vasocontriction, thrombosis, platelet agreggation, oxidant activity, inflammation and growth factors». At this point it is very important that interventional cardiologists define cost/benefit between suppression of restenosis / endothelial dysfunction and the clinical implications of the last one.
On this topic I recommend reading the manuscripts referenced below by Toya et al. and Abdul-Jawad Altisent et al., within the last references in this chapter.
It is surprising to see several observations associated with non-cardiac mortality in patients treated with angioplasty at the present time who were not in previous observations. Actually, this should be a cause for careful analysis in properly conducted randomized clinical trials and prospective registries. This increased non-cardiac mortality was reported not only in randomized clinical trials on DES and CABG, but also in comparisons of different DES designs. As we already know, large enough randomized clinical trials have the power to homogenize populations at a baseline level, which is why the explanation to this increased mortality should be looked for in other clinical settings. I recommend reading Gaudino’s meta-analysis, the 5 years of EXCEL trial, Pilgrim’s et al 5-year study of an «ultrathin DES», the CREDO-Kyoto registry of angioplasties and CABG all referenced below as well as the abstract of the ISCHEMIA trial published in Circulation in November of last year and the European Heart Journal this year. The publication of the last one was the reason of an Editorial comment of ours that is published in the European Heart Journal Open in February of this year and where in a Table we describe all the studies that reported an increase in non-cardiac death with DES in long-term follow-up, to these we must include the findings of the ISCHEMIA study that is really very worrying.
In my opinion calling non-cardiac mortality an adverse event due to coincidence is reckless, illogical, and eventually hurts our own medical specialty.
Only after a sincere discussion of all these findings with opinion leaders and industry CEOs we will be able to escape this labyrinth we fall into with every new randomized trial on CABG or with every medical therapy that only brings us frustration.
Lately even the introduction of methods of functional diagnosis of coronary lesions such as FFR or iFR to guide PCI have not been successful in demonstrating reduction of post-implantation events of DES both in patients with acute infarction or elective patients. I recommend reading the results published this year of randomized studies in this regard including FUTURE, FAME 3 and that of Puymirat E et al in acute myocardial infarction all referenced below between the suggested readings. The negative results of these studies with FFR show us that quickly interventional cardiologists adopt techniques and new «devices» often generating false expectations due to a hasty overestimation of the benefits.
Although the recently published new clinical guidelines on therapeutics elaborated together with clinical cardiologists are somehow benevolent to our medical specialty, they show that, unlike we thought 15 years ago, despite the arrival of state-of-the-art DES designs, coronary artery bypass grafting is more alive than ever. In fact, both American (USA) and European Societies of Cardiovascular and Thoracic surgery didn’t endorse that guideline.
# Creation of the Cardiovascular Research Center (CECI).
In 1986 together with colleagues and friends we formed an independent working group first in the Anchorena Sanatorium and then moved to the Otamendi Sanatorium from 1993 to the present.
During all these years there are no words to describe the support for all our care and scientific tasks developed in the Otamendi, so my thanks to your past authorities Drs. Jose A. De All for whoever comes to work in this Institution and Dr Jorge Aufiero as well as the current authorities.
During all these years, many cardiologists went through the Service to be trained in the practice of our specialty, many of them today Heads of Service in reference places in our country as well as prominent members of scientific societies that could not list them by the quantity, both in our country and in Latin America. Residents of almost all nationalities of the Spanish- and Portuguese-speaking region passed through the service from Paraguay, Chile, Brazil, Bolivia, Peru, Uruguay, Ecuador, Venezuela, Colombia, Panama and the Dominican Republic who then continued to be connected with us, often carrying out joint research work.
Back in 1988, two years after creating a working group with friends and colleagues, we teamed up again to create an independent department of clinical research. Although it was not created as a CRO (there are several examples of excellent CROs in Argentina), it allowed us to arrange multiple research protocols in our country in an orderly fashion, and one by one at the beginning. Afterwards, we conducted multicenter studies including international clinical trials.
Here is a summary of the most significant clinical trials conducted that I think played a key role in our routine clinical practice:
This whole thing started with the first randomized clinical trial published on coronary angioplasty with POBA vs CABG—the ERACI I trial—published in JACC in 1993 and 1995. Years later with the arrival of BMS, the second version of this study, the ERACI II, was published. Unlike the ERACI I, this multicenter trial was co-authored by the fondly remembered Dr. Liliana Grinfeld. Both manuscripts were published in JACC in 2001 and 2005 including the 1- and 5-year follow-up simultaneously published with Dr. Patrick Serruys’ ARTS study.
Back in 1993, we published an observation suggesting that restenosis after balloon angioplasty was mainly due to acute artery recoil after balloon dilatation. Something completely new that we had never associated. In the animal model of restenosis common knowledge was that the endothelial damage due to the mechanism of the angioplasty triggered vessel restenosis months later. However, this was not the case with human beings in whom atherosclerotic plaque is often eccentric and behaves different from the balloon in such a way that the rate of restenosis was very low in lesions whose diameter did not change 24 hours after balloon angioplasty. This finding was published in several scientific journals: American Journal of Cardiology in 1993 and 1995, Circulation in 1995, and JACC in 1998 and also of academic discussions with world opinion leaders since they spoke of: «.. coronary restenosis a time related phenomenom…» therefore our observations were totally opposite and were the subject of controversy. Time proved us right and Patrick Serruys ended up accepting that acute recoil was a very important phenomenon in the pathophysiology of post POBA restenosis, there he began talking about «stent like results post POBA» in other words optimal post-balloon results without acute recoil.
It was very pleasant 3 years ago to see in the gallery of the PCR Congress exposed as one of the milestones of angioplasty precisely the work of our stent in elastic recoil OCBAS trial that was published in JACC 1998 together with the ERACI I and II studies.
In the same sense, it was also very pleasant to read in the book on the history of cardiovascular interventions and interventional cardiology that one of its greatest pioneers Gary Roubin whose aforementioned book was entitled «The First Balloon-Expandable Coronary Stent an Expedition That Changed Cardiovascular Medicine» published in 2015 included us along with Julio Palmaz and Rene Favaloro as the only Latin Americans in the list of the 93 pioneers of Angioplasty and Cardiovascular Interventions, this reference is also within the suggested lectures of this chapter.
The use of stent in the acute myocardial infarction setting is appealing but was also very controversial too. Together with the beloved Dr. Gary Roubin our group published a short experience on the use of stent in the ST-segment elevation myocardial infarction setting in the American Journal of Cardiology back in 1996. This experience immediately turned into the first study on the use of stents in the acute myocardial infarction setting accepted for publication. The GRAMI trial—published in the American Journal of Cardiology in 1998—was contemporaneous to Dr. David Antoniucci’s study. Actually, his study was published two months prior to the JACC publication, but ours had already been accepted two months before the Florence study. Therefore, both chronologically and academically we came first. Anecdotes I always like to remember in our family reunions with my great Italian friend.
Already in the new millennium, the CECI Center participated in prospective records and observational studies such as those related to DES thrombosis published in EuroIntervention in February 2007 («Late stent thrombosis the Damocles sword of DES») a month before the promoted article by Camenzid and Wijns in Circulation, the ERACI III record, which was published in JACC in 2006 and in the Eur Heart J in 2007 this last work was one of the reason why this European Journal will increase its «impact factor» according to a personal letter we received from the Editor-in-Chief of that Journal.
The review article on «DES late thrombosis» there were friends who recommended me not to publish it because it could have adverse reactions from the industry that manufactured the DES, despite those tips, the work was sent and then review accepted and published in EuroIntervention. I must also say that I never felt an adverse reaction from the industry for this.
If the doctors of the CACI specialty career wonder how we were able from Argentina to carry out so many studies that were published in the largest English-speaking «Journals» I would tell them that everything is achieved with work and a lot of honesty in the analysis and observation of the facts that one is seeing. You should always be sure of what you are saying, and you should always check the information several times before making a further judgment if this implies original findings outside of what is established and expected. In fact, at the time where these thoughts were writing, February 20th, 2022, according Research Gate scientific data manuscripts published by us as authors or coauthors deserved 25320 reads,7462 citations and have 3862 points of research interest the largest numbers achieve by any group or individual person in our country in the area of interventional cardiology.
Controversies with our findings happened in several times, with the «elastic recoil», the ERACI studies and with stent in acute myocardial infarction. In these points the collaboration with Igor Palacios, Gary Roubin, John Ambrose, William O’Neill and David Antoniucci were very important. As I said on the occasion of a distinction granted to me by the Legislature of CABA: » the work we did here in Argentina with ideas totally ours and our patients, but nothing would have been the same if our friend from USA or EU didn’t support to us «.
In the ERACI I study, which Favaloro was very angry when we did and spoke ill of the findings including trying to convince the surgeon who had operated on almost all patients not to sign the manuscript once it was approved in the JACC, an Argentine work published in the JACC in 1993 had few precedents in the cardiology of our country, finally cousin rationality and the surgeon signed the work, Dr Néstor Perez-Balino was a faithful witness of what I am recounting. I had, however, the pleasure that several years later, in May 2000, when the new ERACI II had already been accepted for publication, Favaloro called me by phone to congratulate me personally on this work and with warm memories of the past shared in a very difficult moment of the Foundation and also personal of him few months before his death.
Over the last 20 years, the Cardiovascular Research Center (CECI) has conducted several multinational and randomized clinical trials on several DES designs and different revascularization strategies in patients with acute myocardial infarction, as well as in chronic patients.
In this way we participate in the abciximab in acute infarction with a carbon metal stent, JESTENT rheolithic thrombectomy in acute infarction, FREEDOM, FREEDOM long term outcome DES vs CABG in diabetic patients, MULTISTRATEGY on DES and abciximab in acute infarction, VALENTINES with Paclitaxel releasing balloon, DEFINITION II treatment of bifurcations with DES including lesions of unprotected trunk and lately MASTER DAPT comparison of antiplatelet strategy with DES, all of them published several times in NEJM, JAMA, JACC, Circulation, Eur Heart Journal, JACC Intervention and EuroIntervention
Similarly, our database was submitted for analysis and control through several meta-analyses, and eventually, the ERACI and ERACI II clinical trials were submitted for publication (Dr. Pocok in The Lancet, 1995; Dr. Hlatky in The Lancet, 2009 and JACC in 2012; Dr. Daemen in Circulation, 2008, and Dr. Head in The Lancet back in 2018).
Likewise, the database of the EUCATAX trial was submitted to Dr. Valgimigli for the publication of his meta-analysis in The Lancet in 2019, and Circulation in 2021.
Also, based on a prospective registry of multiple vessels, is that the ERACI Score was born as a revascularization strategy in patients with multi-vessel disease and left coronary trunk, which was a joint product of several centers in our country and that tries to reduce the number of DES implanted following anatomical schemes of vessel size and degree of stenosis by angiography, this Score was validated with both the use of DES and BMS.
Last but not least, the studies on the systemic prevention of restenosis with oral immunosuppressant and anti-inflammatory agents after BMS implantation.
Although in the era of balloon angioplasty this strategy did not had favorable results—as a matter of fact no positive results could come from it because the pathophysiology was not inflammatory—in the era of bare metal stents all the randomized clinical trials conducted by us and European working groups in Germany, Italy, Serbia, and Greece on immunosuppressant drugs like rapamycin and/or prednisone had positive results that were summed up in a meta-analysis published by Dr. Kastrati in 2014. Still this strategy was never part of the routine clinical practice.
At this moment, we are conducting a cost-effective randomized clinical trial between state-of-the-art DES vs BMS plus a 3-month course of colchicine only in the BMS group that is still in the recruiting phase. We can only hope it will be completed in the next months.
Given the conflicting and somehow unexpected long-term results with DES, I still believe all options should be on the table and none should be discarded to achieve a greater mid- and long-term efficacy and safety with our percutaneous revascularization procedures whether coronary angioplasty with DES implantation in bifurcation lesions probably including most of unprotected left main coronary artery disease, and BMS implantation in more favorable anatomies, and/or a combination of both strategies.
Nothing should be left out if we want our patients to benefit the most, and if we want to improve this medical specialty that has shaped our lives for so long.
In the last Editor Letter we wrote at JAMA at the beginning of 2021 we told the Editor-in-Chief of the Journal that we thought it was important to publish our letter because we felt that: ….»coronary angioplasty is on the cross roads«…
We need to honestly explain and discuss the origin of our failures and redefine the technique, the «devices» and the indications in another way only the current and new generations of interventional cardiologists will have the niches of patients with acute infarction in progress and / or terminal patients with contraindication of CABG or very short life expectance.
Very little for such a rich history!!!
References suggested
#-Gruentzig AR, Senning A, Siegenthaler WE. Nonoperative dilation of coronary
artery stenosis. Percutaneous transluminal coronary angioplasty.N Eng J Med 1979;301:61-8.
#-Rentrop KP, Cohen M, Hosat ST. Thrombolytic therapy in acute myocardial infarction: review of clinical trials. Am J Cardiol. 1984 Dec 21;54(11):29E-31E
#–Hartzler GO, Rutherford BD, McConahay DR et al: Percutaneous translu-minal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J 1983; 106:965–973.
#- Rodríguez AE, Diaz R, Zuffardi E, Navarro P, de la Fuente LM. Angioplastia
transluminal percutánea coronaria. Rev Arg Cardiol 1982;50(2):78-91.
#. Sigwart U, Puel J, Mirkovich V, Joffre E, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.N Eng J Med 1987;316:701-6.
#. Serruys PW, Juilliere Y, Bertrand ME, Puel J, Rickards AF, Sigwart U. Additionalimprovement of stenosis geometry in human coronary arteries by stenting after balloon dilatation. Am J Cardiol 1988 May9;61(14):71G-76G.
#. Roubin G, Gianturco C, Brown J, Robinson K, King S. Intracoronary stenting of canine coronary arteries after percutaneous coronary angioplasty. Circulation 1986;1986:74.
#. Palmaz JC, Windeler SA, Garcia F, et al. Atherosclerotic rabbit aortas: expandable intraluminal grafts. Radiology 1986;160:723-6.
# Palmaz JC. Balloon expandable intravascular stent. Am J Roentgenol 1988;150,1263-9.
#. Roubin G, Douglas JR, Lembo NJ, Black AJ, King S. Intracoronary stenting for acute closure following percutaneous coronary angioplasty. Circulation 1988;78:407.
#. Schatz RA, Baim DS, Leon M, et al. Clinical experience with the Palmaz-Schatz coronary stent. Initial result of a multicenter study. Circulation 1991;83:148-61.
#. Roubin G, Cannon AD, Agrawal SK, et al. Intracoronary stenting for acuteand threatened closure complications after transluminal coronary angioplasty. Circulation 1992; 85:916-27.
#. Sousa JE, Costa MA, Abizaid AC, et al. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascularultrasound follow-up. Circulation 2001 Oct 23;104(17):2007-11.
#. Rensing BJ, Vos J, Smits PC, et al. Coronary restenosis elimination with a sirolimus eluting stent: first European human experience with 6-month angiographic and intravascular ultrasonic follow-up. Eur Heart J 2001;22(22):2125-30
#Serruys PW, Degertekin M, Tanabe K, et al. RAVEL Study Group. Intravascularultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 2002 Aug 13;106(7):798-803.
#. Grube E, Silber S, Hauptmann KE, et al. TAXUS I: six- and twelve-month results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation 2003 Jan 7;107(1):38-42.
#. Colombo A, Drzewiecki J, Banning A, et al. TAXUS II Study Group. Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions. Circulation 2003 Aug 19;108(7):788-94.
# de la Fuente LM, Miano J, Mrad J et al. Initial results of the Quanam drug eluting stent (QuaDS-QP-2) Registry (BARDDS) in human subjects. Catheter Cardiovasc Interv 2001;53(4):480-8.
#. Grube E, Lansky A, Hauptmann KE, et al. SCORE randomized trial. High-dose 7-hexanoyltaxol-eluting stent with polymer sleeves for coronary revascularization: one-year results from the SCORE randomized trial. J Am Coll Cardiol 2004 Oct 6;44(7):1368-72.
# Rodríguez AE, Santaera O, Larribau M, Sosa MI, Palacios IF. Early decrease in minimal luminal diameter after successful percutaneous transluminal coronary angioplasty predicts late restenosis. Am J Cardiol 1993;71: 1391-5.
#. Rodríguez AE, Santaera O, Larribau M et al. Coronary stenting decreases restenosis in lesions with early loss in luminal diameter 24 hours after successful PTCA. Circulation 1995;91:1397-402.
# Rodríguez A, Ayala F, Bernardi V, Santaera O, Marchand E, Pardiñas C, Mauvecin C, Vogel D, Harrell LC, Palacios IF. Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results. J Am Coll Cardiol 1998 Nov;32(5):1351-7.
#. Fischman DL, Leon MB, Baim D, et al. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496-501.
# Serruys PW, de Jaegere P, Kiemeneij F et al, for the BenestentStudy Group. A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994;331:489-95.
#. * Rodríguez A, Boullon F, Pérez Baliño N, Paviotti C, Sosa Liprandi MI, Palacios IF. Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI): in-hospital results and 1-year follow-up. J Am Coll Cardiol 1993;22:1060-7.
#. Hampton JR, Handerson RA, Julian DG, et al. Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial. Lancet 1993;343:573-80.
#. King SB III, Lembo NJ, Weintraub WS, et al., for the Emory Angioplasty Surgery Trial (EAST). A randomized trial comparing coronary angioplasty with coronary artery bypass surgery. N Engl J Med 1994;331:1044-50.
#. Hamm CW, Reimers J, Ischinger T, Rupprecht HJ, Berger J, Bleifeld W, for the German Angioplasty Bypass Surgery Investigation. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomaticm ultivessel coronary disease. N Engl J Med 1994;331:1037-43.
#. Rodríguez AE, Bernardi V, Navia J et al. Argentine Randomized Study: Coronary Angioplasty with Stenting versus Coronary Bypass Surgery in Patients with Multiple Vessel Disease (ERACI II): 30 days results and on year follow-up results. J Am Coll Cardiol 2001;3:51-8.
#. Serruys PW, Unger F. Sousa JE, et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multi-vessel disease. N Engl J Med 2001;344:1117-24.
#. SoS Investigators Coronary Artery Bypass Surgery versus percutaneous coronary intervention with stent implantation in patients with multi-vessel coronary artery disease (the Stent or Surgery trial): a randomized controlled trial. Lancet 2002;360:965-70.
#. Hueb W, Soares P, Gersh B, et al. The Medicine, Angioplasty, or Surgery Study (MASS II trial): a randomized controlled clinical trial of three therapeutic strategies for multi-vessel coronary artery disease. J Am Coll Cardiol 2004;43:1743-51.
#Roubin GS The First Balloon Expandable Coronary Stent, An Expedition that change Cardiovascular Medicine: A Memoir. University of Queensland Press, St Lucia Queesnland, Australia 2014
#. Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. N Engl J Med 1999; 341:1949-56.
#. Rodríguez AE, Fernández M, Santaera O et al. Coronary stenting in patients undergoing percutaneous transluminal coronary angioplasty during acute myocardial infarction. Am J Cardiol 1996 Apr 1;77(9):685-9.
#. Rodríguez AE, Bernardi V, Fernández J et al. In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Gianturco- Roubin in Acute Myocardial Infarction. Am J Cardiol 1998 Jun 1;81(11):1286-91.
#- Antoniucci D, G.M. Santoro, L. Bolognese, R. Valenti, M. Trapani, P.F. Fazzini A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction J Am Coll Cardiol, 31 (1998), pp. 1234-1239
#. Cassese S, De Luca G, Ribichini F et al. ORAl iMmunosuppressivether apy to prevent in-Stent rEstenosiS (RAMSES) cooperation: a patient-level meta-analysis of randomized trials. Atherosclerosis 2014 Dec;237(2):410-7.
#. Hlatky MA, Boothroyd DB, Bravata DM et al.Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 2009 Apr 4;373(9670):1190-7.
#. Rodríguez AE, Mieres J, Fernández-Pereira C et al. Coronary stent thrombosis in thecurrent drug-eluting stent era: insights from the ERACI III trial. J Am Coll Cardiol 2006 Jan 3;47(1):205-7. Epub 2005 Dec 9.
#. Rodríguez AE, Rodríguez-Granillo GA, Palacios IF. Late stent thrombosis the Damocles sword of Drug Eluting Stents. Eurointervention 2007 Feb; 2(4) 512-7.
#. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation 2007 Mar 20;115(11):1440-55; Epub 2007 Mar 7.
# Rodríguez AE, Maree AO, Mieres J et al.Late loss of early benefit from drug eluting stents when compared with bare metal stents and coronary artery bypass surgery: 3 years follow up of ERACI III registry. Eur Heart J 2007 Sep;29 (17):2118-25.
# Rodríguez AE, Fernández-Pereira C, Rodríguez-Granillo AM.Changes in the safety paradigm with percutaneous coronary interventions in the modern era: Lessons learned from the ASCERT registry.World J Cardiol. 2012 Aug 26;4(8):242-9. doi: 10.4330/wjc.v4.i8.242.
#. Dangas GD, Farkouh ME, Sleeper LA et al, FREEDOM Investigators. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM trial. J Am Coll Cardiol 2014 Sep 23;64(12):1189-97.
#. Antoniucci D, Rodríguez AE, Hempel A et al, A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction. J Am Coll Cardiol 2003 Dec 3;42(11):1879-85.
# Waksman R, Serra A, Loh JP et al. Drug-coated balloons for de novo coronary lesions: results from the Valentines II trial. EuroIntervention 2013 Sep;9(5):613-9.
# Rodríguez AE, Vigo CF, Delacasa A et al,; EUCATAX Investigators. Efficacy and safety of a double-coated paclitaxel-eluting coronary stent: the EUCATAX trial. Catheter Cardiovasc Interv 2011Feb 15;77(3):335-42.
# Zhang JJ, Ye F, Xu K, Kan J, Tao L et al Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J. 2020 Jul 14;41(27):2523-2536
# Rodriguez AE, Fernandez-Pereira C, Mieres J, Santaera O, Antoniucci D; ERACI IV investigators. Modifying angiographic syntax score according to PCI strategy: lessons learnt from ERACI IV Study.Cardiovasc Revasc Med. 2015 Oct-Nov;16(7):418-20. doi: 10.1016/j.carrev.2015.07.001
# Rodriguez AE, Fernandez-Pereira C, Mieres J, et al Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):792-794
# Rioufol G, Dérimay F, Roubille F,et al Fractional Flow Reserve to Guide Treatment of Patients With Multivessel Coronary Artery Disease.FUTURE Trial Investigators.J Am Coll Cardiol. 2021 Nov 9;78(19):1875-1885
# Fearon WF, Zimmermann FM, De Bruyne B et al Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass SurgeryN Engl J Med . 2021 Nov 4. doi: 10.1056/NEJMoa2112299. Online ahead of print.
# Puymirat E, Cayla G, Simon T et al Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction N Engl J Med. 2021 Jul 22;385(4):297-308.,
# Gaudino, M; Hameed, I; Farkouh ME et al, Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery A Meta-analysis; JAMA Intern Med. doi:10.1001/jamainternmed.2020.4748 Published online October 12, 2020.
# Rodríguez-Granillo AM, Fernández-Pereira C, Rodríguez AE.Drug-Eluting vs Bare-Metal Stents for Percutaneous Coronary Intervention. JAMA Intern Med. 2021 Jul 1;181(7):1012-1013. doi: 10.1001/jamainternmed.2021.0030.
# Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018;391:939–48.
# Stone GW, Kappetein AP, Sabik JF et al Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.EXCEL Trial Investigators. N Engl J Med. 2019 Nov 7;381(19):1820-1830
# Park DW, Ahn JM, Yun SC, et al. Ten-year outcomes of stents versus coronary artery bypass grafting for left main coronary artery disease. J Am Coll Cardiol 2018;72 Pt A:2813–22.
# Pavlovsky H, Rodriguez-Granillo AM, Rodriguez AE.Late Mortality After Drug-Eluting, Bare-Metal Stents, and Coronary Bypass Surgery in Left Main Disease. J Am Coll Cardiol. 2019 Apr 9;73(13):1737
# Holm NR, Mäkikallio T, Lindsay MM et al NOBLE investigators. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2020 Jan 18;395(10219):191-
# Daemen J, Boersma E, Flather M et al Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials. Circulation. 2008 Sep 9;118(11):1146-54.
# Flather M, Rhee JW, Boothroyd DB et al The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials.J Am Coll Cardiol. 2012 Nov 20;60(21):2150-7.
# Pilgrim T, Piccolo R, Heg D et al Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial Lancet. 2018 Sep 1;392(10149):737-746.
# Hironori H, Masafumi On, Hideyuki K, et al Impact of stent length and diameter on 10-year mortality in the SYNTAXES trial Catheter Cardiovasc Interv . 2021 Sep;98(3):E379-E387.
# Gomes WJ, Albuquerque LC, Jatene FB, Leal JCF, Rocha EAV, Almeida RMS.The transfiguration of the EXCEL trial: exceeding ethical and moral boundaries.Eur J Cardiothorac Surg. 2020 Jul 1;58(1):30-34.
# Fearon WF, Zimmermann FM, De Bruyne B et al; FAME 3 Investigators.Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. N Engl J Med. 2021 Nov 4. doi: 10.1056/NEJMoa2112299.
# Sabatine M, Bergmark B, Murphy S et al Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis Lancet. 2021 Dec 18;398(10318):2247-2257.
# Gaudino M, Hameed I, Di Franco A, Naik A, Demetres M, Biondi-Zoccai G, Bangalore S. Comparison of SYNTAX score strata effects of percutaneous and surgical revascularization trials: A meta-analysis J Thorac Cardiovasc Surg. 2021 Jun 2:S0022-5223(21)00881-3
# Piccolo R, Bonaa KH, Efthimiou O et al Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization. Coronary Stent Trialists’ (CST) Collaboration. J Am Heart Assoc. 2021 Oct 19;10(20):e018828
# Correa-Sadouet C, Rodríguez-Granillo AM, Gallardo C et al; ORCA investigators. Randomized comparison between bare-metal stent plus colchicine versus drug-eluting stent alone in prevention of clinical adverse events after percutaneous coronary intervention. Protocol Future Cardiol. 2021 Jul;17(4):539-547
# Piccolo R, Bonaa KH, Efthimiou O, et al Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.Coronary Stent Trialists’ Collaboration.Lancet. 2019 Jun 22;393(10190):2503-25
# Zhang JJ, Ye F, Xu K, Kan J et al Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J. 2020 Jul 14;41(27):2523-2536
# Mieres J, Rodríguez AE, Fernández-Pereira C, Ascarrunz-Cattoretti D.Increased incidence of serious late adverse events with drug-eluting stents when compared with coronary artery bypass surgery: a cause of concern. Future Cardiol. 2020 Nov;16(6):711-723
# Valgimigli M, Campo G, Percoco et al; Multicentre Evaluation of Single High-Dose Bolus Tirofiban vs Abciximab With Sirolimus-Eluting Stent or Bare Metal Stent in Acute Myocardial Infarction Study (MULTISTRATEGY) Investigators.JAMA. 2008 Apr 16;299(15):1788-99
# Writing Committee Members, Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines J Am Coll Cardiol. 2021 Dec 7:S0735-1097(21)06157-X
# Deftereos SG, Beerkens FJ, Shah B et alColchicine in Cardiovascular Disease: In-Depth Review. Circulation. 2022 Jan 4;145(1):61-78. doi: 10.1161/CIRCULATIONAHA.121.056171.
# Matsumura-Nakano Y , Shiomi H, Morimoto T et alComparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3) Am J Cardiol . 2021 Apr 15;145:25-36. doi: 10.1016/j.amjcard.2020.12.076.
# Toya T, Sara JD, Corban MT, Taher R et al Assessment of peripheral endothelial function predicts future risk of solid-tumor cancer Eur J Prev Cardiol. 2020 Apr;27(6):608-618.
# Abdul-Jawad Altisent,, Renier Goncalves-Ramírez L,Leticia Fernández et al Long-term Intra-coronary Structural and Vasomotor Assessment of the Absorb Bioresorbable Vascular Scaffold Am J of Cardiol Am J Cardiol. 2022 Jan 17;S0002-9149(21)01268-6. doi: 10.1016/j.amjcard.2021.12.037.
# Rajendran P, RengarajanT, Thangavel J et al The Vascular Endothelium and Human Diseases
International Journal of Biological Sciences 2013; 9(10):1057-1069
# Sidhu MS, Alexander KP, Huang Z et al Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial Originally published12 Nov 2020Circulation. 2020;142:A13030
# . Lopez-Sendon JL, Cyr DD, Mark DB et al Effects of initial invasive vs. initial conservative treatment strategies on recurrent and total cardiovascular events in the ISCHEMIA trial. Eur Heart J 2022;43:148–149.
# Rodriguez AE,Fernandez-Pereira C, Mieres J and A.Matias Rodriguez-Granillo Is non cardiac death increased with an initial invasive revascularization strategy? Commentary on the ISCHEMIA trial European Heart Journal Open (2022) 00, 1–2 https://doi.org/10.1093/ehjopen/oeac012
My interventional cardiology practice over the last 41 years (1980-2021)
La Cardiología Intervencionista que viví en mis 41 años de práctica
I wish to thank the Argentine College of interventional Cardioangiologists (CACI) for giving me the extraordinary opportunity of becoming a founding member of the College and being able to practice this medical specialty for the past 40 years. .
In the following pages I will try to sum up what I think are the most important experiences lived by my colleagues and I since the beginning of this medical specialty including all that has been going on in this changing and fascinating specialty. Back in 1980, I was the Cardiology/Hemodynamics/Cardiovascular Surgery unit chief resident of Sanatorio Güemes, the then called Favaloro Foundation led by directors Dr. Rene G. Favaloro, and Dr. Luis de la Fuente at the time. It was then that we came up with our first tools to perform peripheral angioplasties of both femoral and renal arteries, still without the operative and technical capabilities to start this therapy in the coronary arteries.
Almost three years had gone by since Dr. Andreas Gruntzig had presented the first cases treated in Zurich, Switzerland back in 1977 in a meeting held by the American Heart Association.
Also, by then, in 1979, Dr, Peter Rentrop had already demonstrated the benefits of intracoronary thrombolysis with streptokinase for the reperfusion patients within the first few hours after an acute myocardial infarction.
Interventional cardiology as we know it was taking off.
It was precisely on October 3, 1980—my birthday by the way—that I had my first therapeutic experience using a catheter to treat the ischemic heart disease of a patient with an ST-segment elevation myocardial infarction.
The patient had sustained a 12-hour postoperative period following a side-to-side anastomosis of venous coronary artery bypass grafts to the left anterior descending coronary and diagonal arteries that showed signs of an extensive anterolateral infarction with hemodynamic compromise.
Dr. Favaloro called the cath lab. I talked to him and suggested the possibility of infusing thrombolytic drugs in the potential occlusion site, in other words, use the saphenous vein to perform the coronary artery bypass grafting.
The famous hematologist Dr. Raúl Altman, a collaborator of Dr. Favaloro, had urokinase available because he often used it for specific treatments.
With these elements we selectively catheterized the occluding bypass, proceeded with the 1-hour in-situ infusion of urokinase, and achieved the reperfusion of the diagonal artery and the entire proximal and middle third of the left anterior descending coronary artery resulting in TIMI grade-3 flow followed by complete hemodynamic stabilization.
I gladly remember Dr. Favaloro called me and told me: «Rodriguez this is the best birthday present you’re getting this year».
I presented the case at a South American congress of cardiology, and two years later it was published as a case report in the Journal of the American Heart Association with another case performed by a different member of the Hemodynamics staff unit.
Despite I personally performed this procedure skin to skin—as we say in our day-to-day medical jargon—I was deliberately excluded from the publication without my knowledge and while on one of my numerous trips to the United States during 1981 and 1982.
Back in 1980, Dr Richard Myler, an angioplasty pioneer in the United States, was giving lectures in Sanatorio Güemes as a guest of Dr. Favaloro. The opportunity was ripe for me to join his team, which I did in January 1981 for three months. Years later, Dr. Myler introduced and inducted me as a fellow of the American College of Cardiology.
At that time, I also had the opportunity of visiting Dr. John Simpson from Stanford University who was practicing with a new steerable system of catheters and moveable core metal guidewires to perform coronary angioplasties. Back in Argentina, in April, we started performing the first coronary angioplasties at Sanatorio Güemes.
Angioplasty in Europe and the United States was on the rise with pioneers like Dr. Andreas Gruntzig from Switzerland, and one of the most notorious of all, Dr. Geoffrey Hartzler from Kansas, United States who pioneered the field of myocardial infarction angioplasty. He is one of the greatest ever, there is no doubt about that. Dr. Hartzler was, unfortunately, gone before his time, but in 1982 he introduced the method to perform primary angioplasties without previous thrombolysis (a method called direct angioplasty).
At the time, acute myocardial infarction angioplasty was very controversial with conflicting results. Also, most angioplasties were being performed after the infusion of thrombolytic drugs.
At the end of 1981, one year after having performed the aforementioned intracoronary thrombolysis, I had the opportunity to perform an angioplasty after thrombolysis on a patient with an inferior wall ST-segment elevation myocardial infarction due to right coronary artery occlusion. The first thing I did was coronary artery reperfusion with the intracoronary infusion of urokinase and then perform the balloon angioplasty. The procedure was a success.
The case was published at the beginning of 1982 in the Argentine Journal of Cardiology. To my knowledge, this was the first case of coronary angioplasty after thrombolysis ever performed in Latin America in the acute myocardial infarction setting. Probably, only a German team had performed the same procedure that same year of 1982 publishing the case in Circulation.
During the 1980s our specialty skyrockets in the entire Western world both in the United States and Europe. Also, the late 1980s see the birth of plain old balloon angioplasty (POBA) and new devices like directional coronary atherectomy, rotablation, balloon dilatation catheters, and prolonged infusions, etc. allowing us to develop more complex angioplasties than the one initially performed by Dr. Gruentzig.
It wasn’t until the mid-1980s (1986) that we created our own clinical research working group, the Cardiovascular Research Center (CECI) based on Buenos Aires, Argentina. A research center that still stands today.
At that time, the first limited but very promising experiences with bare metal stents (BMS) to prevent coronary occlusions during balloon angioplasty were beginning to take shape. Names like Dr. Sigwart, Dr. Puel, Dr. Marco, Dr. Serruys, Dr. Roubin, and Dr. Palmaz started to make a difference in all scientific settings of our specialty.
# Decades of 1990/2000/2010. The dramatic ascent of coronary angioplasty as therapeutic procedure for the management of acute and chronic coronary patients.
In my humble opinion, these were the golden decades of our medical specialty.
The first decade of 1990/2000 witnessed a consolidation in the use of bare metal stents (BMS) during angioplasty to treat acute complications and coronary restenosis after POBA to avoid chronic and acute recoil after balloon angioplasty. At the time, this was the leading cause of restenosis after this procedure. The use of BMS was first introduced in the United States by Dr. Roubin and Dr. Palmaz with their balloon-expandable stents. Dr. Gianturco-Roubin’s was the first BMS approved by the FDA in the United States to treat acute complications followed shortly after by Palmaz-Schatz’s stents .
Stents eventually would be used in all clinical conditions including the acute myocardial infarction setting and very complex coronary lesions.
Also, this decade witnesses the publication of the first randomized clinical trials on coronary angioplasty with POBA vs coronary artery bypass graft (CABG) in patients with simple obstructions of multiple vessels, most of them with chronic coronary artery disease, also in diabetic patients. Shortly after these same comparisons would be made with the use of BMS . This is also the time when the first comparative randomized trials on acute myocardial infarctions treated with angioplasty vs thrombolysis are published followed by studies on angioplasty with POBA vs angioplasty with stenting .
During this decade two landmark meta-analyses confirmed that, in the long run, the angioplasty in patients with multivessel disease has the same survival and infarction-free survival rates compared to CABG excluding diabetic patients. In these analyses the survival rate of young patients showed a clear advantage towards the angioplasty, which is comprehensible, but was confirmed in this meta-analysis for the first time. The only difference in favor of CABG was the higher rate of new requirements for angioplasty revascularization.
Unfortunately, these findings were published,2008-2009, just when drug-eluting stents (DES) were on the rise, which is why these results were overlooked.
Although the use of bare metal stents minimized the occurrence of acute complications after angioplasty, it also caused in-stent restenosis due to fibrous intimal hyperplasia following the exaggerated scarring caused by new reinterventions of the target vessel within the first 8 to 10 months after stenting (> 20% rate).
The introduction of immunosuppressive drugs within the stent to be released in the arterial endothelium within the first month after stenting caused a significant reduction of this hyperplasia followed by a significant reduction of new revascularizations. Also, this combination prevented acute recoil and fibrous intimal hyperplasia.
This marked the beginning of DES that revolutionized our medical specialty. Actually, to this date, in certain discussion fora—not mine—they still revolutionize our specialty.
Esto es el inicio de los stents liberadores de fármacos (DES) que revolucionaron y aun hoy en algunos foros de discusión, no en el mío propio, siguen revolucionando nuestra especialidad. The names of Antonio Colombo, Eberhard Grube, Martin Leon, Patrick W. Serruys and Greg Stone are largely due to them this technological leap with the introduction of drug-eluting stents (DES). At this point, our colleague Eduardo Sousa and his group in Brazil also played an important role. However, our country was again not absent in this development of deS, and one of the observational studies in its use was carried out in Argentina by Dr Luis de la Fuente and despite the fact that his findings were not endorsed by a long multinational randomized European study, which had to be terminated prematurely due to excess of thrombotic complications of this DES design, this pilot study was pioneering at the time.
The significant reduction of new revascularizations reported after DES implantation brought expectations that were a little too optimistic regarding the use of stents like this. Rumor had it that «the end of restenosis would also be the end of CABG» following the early findings from the first randomized clinical trials on the use of DES. In the following section we will see how far we still are from these predictions.
This overoptimistic approach was built on reducing completely secondary and non-clinical endpoints to a minimum like minimizing the so-called “late loss” that could never be associated with the occurrence of hard endpoints after angioplasty.
# Decade of 2010/2021. The dramatic ascent of the indication of revascularization to the present day.
At this point I want to be very straightforward, but also very critical, and my opinions should also be taken from this personal point of view.
With the arrival of DES into the routine clinical practice, to this date, several randomized clinical trials including comparison groups have been conducted on angioplasty with DES vs CABG. As a matter of fact, up to 3 studies on unprotected left main coronary artery disease, 1 on multiple vessels and left main coronary artery, and the remaining 4 on multiple vessels including diabetic patients have been conducted.
From the beginning, all trials but 1 invariably showed more revascularization procedures as a natural companion of the angioplasty, which should not worry us. However, in 7 of these trials, the mortality and/or spontaneous myocardial infarction rates also went up, which is more disturbing and is associated with mortality.
The greater complexity of the patients treated could explain these findings, but it is probably not the only hypothesis. As a matter of fact, several meta-analyses proved that regardless of the anatomical complexity, the rate of hard endpoints like myocardial infarction—and in some studies, mortality—was lower with CABG.
This change in safety parameters in comparative studies with surgery had already been observed in the long American registry of ASCERT with 190 thousand patients treated with CABG and PCI (78% DES1) during the years 2004 to 2008 in 64 sites in the USA and where in patients >64 years there was a significant reduction in mortality with CABG even in groups of low angiographic and clinical risk (non-diabetic and two-vessel injury). and what a reason why we wrote a review article in 2012, where we already drew attention to these findings. This reference is among the suggested articles to read.
Although it is completely true that DES reduced significantly the rate of new revascularizations, mortality did not change when the old DES and/or even BMS designs were compared to the new ones.
With the first designs, the use of DES had 4 limitations some of which overlap:
1- Early, late, and very late stent thrombosis.
2- Poor late DES apposition. These 2 overlapped most of the times.
3- Early neo-atherosclerosis immediately after implantation (beyond 1st year).
4- Endothelial dysfunction both in the stent and in the proximal and distal segments of the implant.
Stent thrombosis and poor stent apposition were significantly associated with the polymer, but, to this date, this is not a problem anymore.
However, the 2 remaining ones—early neo-atherosclerosis and endothelial dysfunction—were mainly associated with the local action of the immunosuppressant drug. The former causes spontaneous infarctions not associated with new procedures that we have been invariably seeing in all randomized trials including comparison groups on CABG. Endothelial dysfunction is also associated with cardiac adverse events, but ultimately with non-cardiac adverse events too including a higher incidence rate of solid tumors.
It should not be forgotten that the endothelium is an organ with multiple functions such as: «vasodilation, thrombolysis, platelet disagreggation, antioxidant, antiinflammation, antiproliferation». The loss of its normal function i.e. endothelial dysfunction could produce the opposite effects: «vasocontriction, thrombosis, platelet agreggation, oxidant activity, inflammation and growth factors». At this point it is very important that interventional cardiologists define cost/benefit between suppression of restenosis / endothelial dysfunction and the clinical implications of the last one.
On this topic I recommend reading the manuscripts referenced below by Toya et al. and Abdul-Jawad Altisent et al., within the last references in this chapter.
It is surprising to see several observations associated with non-cardiac mortality in patients treated with angioplasty at the present time who were not in previous observations. Actually, this should be a cause for careful analysis in properly conducted randomized clinical trials and prospective registries. This increased non-cardiac mortality was reported not only in randomized clinical trials on DES and CABG, but also in comparisons of different DES designs. As we already know, large enough randomized clinical trials have the power to homogenize populations at a baseline level, which is why the explanation to this increased mortality should be looked for in other clinical settings. I recommend reading Gaudino’s meta-analysis, the 5 years of EXCEL trial, Pilgrim’s et al 5-year study of an «ultrathin DES», the CREDO-Kyoto registry of angioplasties and CABG all referenced below as well as the abstract of the ISCHEMIA trial published in Circulation in November of last year and the European Heart Journal this year. The publication of the last one was the reason of an Editorial comment of ours that is published in the European Heart Journal Open in February of this year and where in a Table we describe all the studies that reported an increase in non-cardiac death with DES in long-term follow-up, to these we must include the findings of the ISCHEMIA study that is really very worrying.
In my opinion calling non-cardiac mortality an adverse event due to coincidence is reckless, illogical, and eventually hurts our own medical specialty.
Only after a sincere discussion of all these findings with opinion leaders and industry CEOs we will be able to escape this labyrinth we fall into with every new randomized trial on CABG or with every medical therapy that only brings us frustration.
Lately even the introduction of methods of functional diagnosis of coronary lesions such as FFR or iFR to guide PCI have not been successful in demonstrating reduction of post-implantation events of DES both in patients with acute infarction or elective patients. I recommend reading the results published this year of randomized studies in this regard including FUTURE, FAME 3 and that of Puymirat E et al in acute myocardial infarction all referenced below between the suggested readings. The negative results of these studies with FFR show us that quickly interventional cardiologists adopt techniques and new «devices» often generating false expectations due to a hasty overestimation of the benefits.
Although the recently published new clinical guidelines on therapeutics elaborated together with clinical cardiologists are somehow benevolent to our medical specialty, they show that, unlike we thought 15 years ago, despite the arrival of state-of-the-art DES designs, coronary artery bypass grafting is more alive than ever. In fact, both American (USA) and European Societies of Cardiovascular and Thoracic surgery didn’t endorse that guideline.
# Creation of the Cardiovascular Research Center (CECI).
In 1986 together with colleagues and friends we formed an independent working group first in the Anchorena Sanatorium and then moved to the Otamendi Sanatorium from 1993 to the present.
During all these years there are no words to describe the support for all our care and scientific tasks developed in the Otamendi, so my thanks to your past authorities Drs. Jose A. De All for whoever comes to work in this Institution and Dr Jorge Aufiero as well as the current authorities.
During all these years, many cardiologists went through the Service to be trained in the practice of our specialty, many of them today Heads of Service in reference places in our country as well as prominent members of scientific societies that could not list them by the quantity, both in our country and in Latin America. Residents of almost all nationalities of the Spanish- and Portuguese-speaking region passed through the service from Paraguay, Chile, Brazil, Bolivia, Peru, Uruguay, Ecuador, Venezuela, Colombia, Panama and the Dominican Republic who then continued to be connected with us, often carrying out joint research work.
Back in 1988, two years after creating a working group with friends and colleagues, we teamed up again to create an independent department of clinical research. Although it was not created as a CRO (there are several examples of excellent CROs in Argentina), it allowed us to arrange multiple research protocols in our country in an orderly fashion, and one by one at the beginning. Afterwards, we conducted multicenter studies including international clinical trials.
Here is a summary of the most significant clinical trials conducted that I think played a key role in our routine clinical practice:
This whole thing started with the first randomized clinical trial published on coronary angioplasty with POBA vs CABG—the ERACI I trial—published in JACC in 1993 and 1995. Years later with the arrival of BMS, the second version of this study, the ERACI II, was published. Unlike the ERACI I, this multicenter trial was co-authored by the fondly remembered Dr. Liliana Grinfeld. Both manuscripts were published in JACC in 2001 and 2005 including the 1- and 5-year follow-up simultaneously published with Dr. Patrick Serruys’ ARTS study.
Back in 1993, we published an observation suggesting that restenosis after balloon angioplasty was mainly due to acute artery recoil after balloon dilatation. Something completely new that we had never associated. In the animal model of restenosis common knowledge was that the endothelial damage due to the mechanism of the angioplasty triggered vessel restenosis months later. However, this was not the case with human beings in whom atherosclerotic plaque is often eccentric and behaves different from the balloon in such a way that the rate of restenosis was very low in lesions whose diameter did not change 24 hours after balloon angioplasty. This finding was published in several scientific journals: American Journal of Cardiology in 1993 and 1995, Circulation in 1995, and JACC in 1998 and also of academic discussions with world opinion leaders since they spoke of: «.. coronary restenosis a time related phenomenom…» therefore our observations were totally opposite and were the subject of controversy. Time proved us right and Patrick Serruys ended up accepting that acute recoil was a very important phenomenon in the pathophysiology of post POBA restenosis, there he began talking about «stent like results post POBA» in other words optimal post-balloon results without acute recoil.
It was very pleasant 3 years ago to see in the gallery of the PCR Congress exposed as one of the milestones of angioplasty precisely the work of our stent in elastic recoil OCBAS trial that was published in JACC 1998 together with the ERACI I and II studies.
In the same sense, it was also very pleasant to read in the book on the history of cardiovascular interventions and interventional cardiology that one of its greatest pioneers Gary Roubin whose aforementioned book was entitled «The First Balloon-Expandable Coronary Stent an Expedition That Changed Cardiovascular Medicine» published in 2015 included us along with Julio Palmaz and Rene Favaloro as the only Latin Americans in the list of the 93 pioneers of Angioplasty and Cardiovascular Interventions, this reference is also within the suggested lectures of this chapter.
The use of stent in the acute myocardial infarction setting is appealing but was also very controversial too. Together with the beloved Dr. Gary Roubin our group published a short experience on the use of stent in the ST-segment elevation myocardial infarction setting in the American Journal of Cardiology back in 1996. This experience immediately turned into the first study on the use of stents in the acute myocardial infarction setting accepted for publication. The GRAMI trial—published in the American Journal of Cardiology in 1998—was contemporaneous to Dr. David Antoniucci’s study. Actually, his study was published two months prior to the JACC publication, but ours had already been accepted two months before the Florence study. Therefore, both chronologically and academically we came first. Anecdotes I always like to remember in our family reunions with my great Italian friend.
Already in the new millennium, the CECI Center participated in prospective records and observational studies such as those related to DES thrombosis published in EuroIntervention in February 2007 («Late stent thrombosis the Damocles sword of DES») a month before the promoted article by Camenzid and Wijns in Circulation, the ERACI III record, which was published in JACC in 2006 and in the Eur Heart J in 2007 this last work was one of the reason why this European Journal will increase its «impact factor» according to a personal letter we received from the Editor-in-Chief of that Journal.
The review article on «DES late thrombosis» there were friends who recommended me not to publish it because it could have adverse reactions from the industry that manufactured the DES, despite those tips, the work was sent and then review accepted and published in EuroIntervention. I must also say that I never felt an adverse reaction from the industry for this.
If the doctors of the CACI specialty career wonder how we were able from Argentina to carry out so many studies that were published in the largest English-speaking «Journals» I would tell them that everything is achieved with work and a lot of honesty in the analysis and observation of the facts that one is seeing. You should always be sure of what you are saying, and you should always check the information several times before making a further judgment if this implies original findings outside of what is established and expected. In fact, at the time where these thoughts were writing, April 30 th, 2022, according Research Gate scientific data manuscripts published by us as authors or coauthors deserved 26222 reads,7568 citations and have 3920 points of research interest the largest numbers achieve by any group or individual person in our country in the area of interventional cardiology.
Controversies with our findings happened in several times, with the «elastic recoil», the ERACI studies and with stent in acute myocardial infarction. In these points the collaboration with Igor Palacios, Gary Roubin, John Ambrose, William O’Neill and David Antoniucci were very important. As I said on the occasion of a distinction granted to me by the Legislature of CABA: » the work we did here in Argentina with ideas totally ours and our patients, but nothing would have been the same if our friend from USA or EU didn’t support to us «.
In the ERACI I study, which Favaloro was very angry when we did and spoke ill of the findings including trying to convince the surgeon who had operated on almost all patients not to sign the manuscript once it was approved in the JACC, an Argentine work published in the JACC in 1993 had few precedents in the cardiology of our country, finally cousin rationality and the surgeon signed the work, Dr Néstor Perez-Balino was a faithful witness of what I am recounting. I had, however, the pleasure that several years later, in May 2000, when the new ERACI II had already been accepted for publication, Favaloro called me by phone to congratulate me personally on this work and with warm memories of the past shared in a very difficult moment of the Foundation and also personal of him few months before his death.
Over the last 20 years, the Cardiovascular Research Center (CECI) has conducted several multinational and randomized clinical trials on several DES designs and different revascularization strategies in patients with acute myocardial infarction, as well as in chronic patients.
In this way we participate in the abciximab in acute infarction with a carbon metal stent, JESTENT rheolithic thrombectomy in acute infarction, FREEDOM, FREEDOM long term outcome DES vs CABG in diabetic patients, MULTISTRATEGY on DES and abciximab in acute infarction, VALENTINES with Paclitaxel releasing balloon, DEFINITION II treatment of bifurcations with DES including lesions of unprotected trunk and lately MASTER DAPT comparison of antiplatelet strategy with DES, all of them published several times in NEJM, JAMA, JACC, Circulation, Eur Heart Journal, JACC Intervention and EuroIntervention
Similarly, our database was submitted for analysis and control through several meta-analyses, and eventually, the ERACI and ERACI II clinical trials were submitted for publication (Dr. Pocok in The Lancet, 1995; Dr. Hlatky in The Lancet, 2009 and JACC in 2012; Dr. Daemen in Circulation, 2008, and Dr. Head in The Lancet back in 2018).
Likewise, the database of the EUCATAX trial was submitted to Dr. Valgimigli for the publication of his meta-analysis in The Lancet in 2019, and Circulation in 2021.
Also, based on a prospective registry of multiple vessels, is that the ERACI Score was born as a revascularization strategy in patients with multi-vessel disease and left coronary trunk, which was a joint product of several centers in our country and that tries to reduce the number of DES implanted following anatomical schemes of vessel size and degree of stenosis by angiography, this Score was validated with both the use of DES and BMS.
Last but not least, the studies on the systemic prevention of restenosis with oral immunosuppressant and anti-inflammatory agents after BMS implantation.
Although in the era of balloon angioplasty this strategy did not had favorable results—as a matter of fact no positive results could come from it because the pathophysiology was not inflammatory—in the era of bare metal stents all the randomized clinical trials conducted by us and European working groups in Germany, Italy, Serbia, and Greece on immunosuppressant drugs like rapamycin and/or prednisone had positive results that were summed up in a meta-analysis published by Dr. Kastrati in 2014. Still this strategy was never part of the routine clinical practice.
At this moment, we are conducting a cost-effective randomized clinical trial between state-of-the-art DES vs BMS plus a 3-month course of colchicine only in the BMS group that is still in the recruiting phase. We can only hope it will be completed in the next months.
Given the conflicting and somehow unexpected long-term results with DES, I still believe all options should be on the table and none should be discarded to achieve a greater mid- and long-term efficacy and safety with our percutaneous revascularization procedures whether coronary angioplasty with DES implantation in bifurcation lesions probably including most of unprotected left main coronary artery disease, and BMS implantation in more favorable anatomies, and/or a combination of both strategies.
Nothing should be left out if we want our patients to benefit the most, and if we want to improve this medical specialty that has shaped our lives for so long.
In the last Editor Letter we wrote at JAMA at the beginning of 2021 we told the Editor-in-Chief of the Journal that we thought it was important to publish our letter because we felt that: ….»coronary angioplasty is on the cross roads«…
We need to honestly explain and discuss the origin of our failures and redefine the technique, the «devices» and the indications in another way only the current and new generations of interventional cardiologists will have the niches of patients with acute infarction in progress and / or terminal patients with contraindication of CABG or very short life expectance.
Very little for such a rich history!!!
References suggested
#-Gruentzig AR, Senning A, Siegenthaler WE. Nonoperative dilation of coronary
artery stenosis. Percutaneous transluminal coronary angioplasty.N Eng J Med 1979;301:61-8.
#-Rentrop KP, Cohen M, Hosat ST. Thrombolytic therapy in acute myocardial infarction: review of clinical trials. Am J Cardiol. 1984 Dec 21;54(11):29E-31E
#–Hartzler GO, Rutherford BD, McConahay DR et al: Percutaneous translu-minal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J 1983; 106:965–973.
#- Rodríguez AE, Diaz R, Zuffardi E, Navarro P, de la Fuente LM. Angioplastia
transluminal percutánea coronaria. Rev Arg Cardiol 1982;50(2):78-91.
#. Sigwart U, Puel J, Mirkovich V, Joffre E, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.N Eng J Med 1987;316:701-6.
#. Serruys PW, Juilliere Y, Bertrand ME, Puel J, Rickards AF, Sigwart U. Additionalimprovement of stenosis geometry in human coronary arteries by stenting after balloon dilatation. Am J Cardiol 1988 May9;61(14):71G-76G.
#. Roubin G, Gianturco C, Brown J, Robinson K, King S. Intracoronary stenting of canine coronary arteries after percutaneous coronary angioplasty. Circulation 1986;1986:74.
#. Palmaz JC, Windeler SA, Garcia F, et al. Atherosclerotic rabbit aortas: expandable intraluminal grafts. Radiology 1986;160:723-6.
# Palmaz JC. Balloon expandable intravascular stent. Am J Roentgenol 1988;150,1263-9.
#. Roubin G, Douglas JR, Lembo NJ, Black AJ, King S. Intracoronary stenting for acute closure following percutaneous coronary angioplasty. Circulation 1988;78:407.
#. Schatz RA, Baim DS, Leon M, et al. Clinical experience with the Palmaz-Schatz coronary stent. Initial result of a multicenter study. Circulation 1991;83:148-61.
#. Roubin G, Cannon AD, Agrawal SK, et al. Intracoronary stenting for acuteand threatened closure complications after transluminal coronary angioplasty. Circulation 1992; 85:916-27.
#. Sousa JE, Costa MA, Abizaid AC, et al. Sustained suppression of neointimal proliferation by sirolimus-eluting stents: one-year angiographic and intravascularultrasound follow-up. Circulation 2001 Oct 23;104(17):2007-11.
#. Rensing BJ, Vos J, Smits PC, et al. Coronary restenosis elimination with a sirolimus eluting stent: first European human experience with 6-month angiographic and intravascular ultrasonic follow-up. Eur Heart J 2001;22(22):2125-30
#Serruys PW, Degertekin M, Tanabe K, et al. RAVEL Study Group. Intravascularultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 2002 Aug 13;106(7):798-803.
#. Grube E, Silber S, Hauptmann KE, et al. TAXUS I: six- and twelve-month results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation 2003 Jan 7;107(1):38-42.
#. Colombo A, Drzewiecki J, Banning A, et al. TAXUS II Study Group. Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions. Circulation 2003 Aug 19;108(7):788-94.
# de la Fuente LM, Miano J, Mrad J et al. Initial results of the Quanam drug eluting stent (QuaDS-QP-2) Registry (BARDDS) in human subjects. Catheter Cardiovasc Interv 2001;53(4):480-8.
#. Grube E, Lansky A, Hauptmann KE, et al. SCORE randomized trial. High-dose 7-hexanoyltaxol-eluting stent with polymer sleeves for coronary revascularization: one-year results from the SCORE randomized trial. J Am Coll Cardiol 2004 Oct 6;44(7):1368-72.
# Rodríguez AE, Santaera O, Larribau M, Sosa MI, Palacios IF. Early decrease in minimal luminal diameter after successful percutaneous transluminal coronary angioplasty predicts late restenosis. Am J Cardiol 1993;71: 1391-5.
#. Rodríguez AE, Santaera O, Larribau M et al. Coronary stenting decreases restenosis in lesions with early loss in luminal diameter 24 hours after successful PTCA. Circulation 1995;91:1397-402.
# Rodríguez A, Ayala F, Bernardi V, Santaera O, Marchand E, Pardiñas C, Mauvecin C, Vogel D, Harrell LC, Palacios IF. Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results. J Am Coll Cardiol 1998 Nov;32(5):1351-7.
#. Fischman DL, Leon MB, Baim D, et al. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496-501.
# Serruys PW, de Jaegere P, Kiemeneij F et al, for the BenestentStudy Group. A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994;331:489-95.
#. * Rodríguez A, Boullon F, Pérez Baliño N, Paviotti C, Sosa Liprandi MI, Palacios IF. Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI): in-hospital results and 1-year follow-up. J Am Coll Cardiol 1993;22:1060-7.
#. Hampton JR, Handerson RA, Julian DG, et al. Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial. Lancet 1993;343:573-80.
#. King SB III, Lembo NJ, Weintraub WS, et al., for the Emory Angioplasty Surgery Trial (EAST). A randomized trial comparing coronary angioplasty with coronary artery bypass surgery. N Engl J Med 1994;331:1044-50.
#. Hamm CW, Reimers J, Ischinger T, Rupprecht HJ, Berger J, Bleifeld W, for the German Angioplasty Bypass Surgery Investigation. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomaticm ultivessel coronary disease. N Engl J Med 1994;331:1037-43.
#. Rodríguez AE, Bernardi V, Navia J et al. Argentine Randomized Study: Coronary Angioplasty with Stenting versus Coronary Bypass Surgery in Patients with Multiple Vessel Disease (ERACI II): 30 days results and on year follow-up results. J Am Coll Cardiol 2001;3:51-8.
#. Serruys PW, Unger F. Sousa JE, et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multi-vessel disease. N Engl J Med 2001;344:1117-24.
#. SoS Investigators Coronary Artery Bypass Surgery versus percutaneous coronary intervention with stent implantation in patients with multi-vessel coronary artery disease (the Stent or Surgery trial): a randomized controlled trial. Lancet 2002;360:965-70.
#. Hueb W, Soares P, Gersh B, et al. The Medicine, Angioplasty, or Surgery Study (MASS II trial): a randomized controlled clinical trial of three therapeutic strategies for multi-vessel coronary artery disease. J Am Coll Cardiol 2004;43:1743-51.
#Roubin GS The First Balloon Expandable Coronary Stent, An Expedition that change Cardiovascular Medicine: A Memoir. University of Queensland Press, St Lucia Queesnland, Australia 2014
#. Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. N Engl J Med 1999; 341:1949-56.
#. Rodríguez AE, Fernández M, Santaera O et al. Coronary stenting in patients undergoing percutaneous transluminal coronary angioplasty during acute myocardial infarction. Am J Cardiol 1996 Apr 1;77(9):685-9.
#. Rodríguez AE, Bernardi V, Fernández J et al. In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Gianturco- Roubin in Acute Myocardial Infarction. Am J Cardiol 1998 Jun 1;81(11):1286-91.
#- Antoniucci D, G.M. Santoro, L. Bolognese, R. Valenti, M. Trapani, P.F. Fazzini A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction J Am Coll Cardiol, 31 (1998), pp. 1234-1239
#. Cassese S, De Luca G, Ribichini F et al. ORAl iMmunosuppressivether apy to prevent in-Stent rEstenosiS (RAMSES) cooperation: a patient-level meta-analysis of randomized trials. Atherosclerosis 2014 Dec;237(2):410-7.
#. Hlatky MA, Boothroyd DB, Bravata DM et al.Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 2009 Apr 4;373(9670):1190-7.
#. Rodríguez AE, Mieres J, Fernández-Pereira C et al. Coronary stent thrombosis in thecurrent drug-eluting stent era: insights from the ERACI III trial. J Am Coll Cardiol 2006 Jan 3;47(1):205-7. Epub 2005 Dec 9.
#. Rodríguez AE, Rodríguez-Granillo GA, Palacios IF. Late stent thrombosis the Damocles sword of Drug Eluting Stents. Eurointervention 2007 Feb; 2(4) 512-7.
#. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation 2007 Mar 20;115(11):1440-55; Epub 2007 Mar 7.
# Rodríguez AE, Maree AO, Mieres J et al.Late loss of early benefit from drug eluting stents when compared with bare metal stents and coronary artery bypass surgery: 3 years follow up of ERACI III registry. Eur Heart J 2007 Sep;29 (17):2118-25.
# Rodríguez AE, Fernández-Pereira C, Rodríguez-Granillo AM.Changes in the safety paradigm with percutaneous coronary interventions in the modern era: Lessons learned from the ASCERT registry.World J Cardiol. 2012 Aug 26;4(8):242-9. doi: 10.4330/wjc.v4.i8.242.
#. Dangas GD, Farkouh ME, Sleeper LA et al, FREEDOM Investigators. Long-term outcome of PCI versus CABG in insulin and non-insulin-treated diabetic patients: results from the FREEDOM trial. J Am Coll Cardiol 2014 Sep 23;64(12):1189-97.
#. Antoniucci D, Rodríguez AE, Hempel A et al, A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction. J Am Coll Cardiol 2003 Dec 3;42(11):1879-85.
# Waksman R, Serra A, Loh JP et al. Drug-coated balloons for de novo coronary lesions: results from the Valentines II trial. EuroIntervention 2013 Sep;9(5):613-9.
# Rodríguez AE, Vigo CF, Delacasa A et al,; EUCATAX Investigators. Efficacy and safety of a double-coated paclitaxel-eluting coronary stent: the EUCATAX trial. Catheter Cardiovasc Interv 2011Feb 15;77(3):335-42.
# Zhang JJ, Ye F, Xu K, Kan J, Tao L et al Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J. 2020 Jul 14;41(27):2523-2536
# Rodriguez AE, Fernandez-Pereira C, Mieres J, Santaera O, Antoniucci D; ERACI IV investigators. Modifying angiographic syntax score according to PCI strategy: lessons learnt from ERACI IV Study.Cardiovasc Revasc Med. 2015 Oct-Nov;16(7):418-20. doi: 10.1016/j.carrev.2015.07.001
# Rodriguez AE, Fernandez-Pereira C, Mieres J, et al Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score.Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):792-794
# Rioufol G, Dérimay F, Roubille F,et al Fractional Flow Reserve to Guide Treatment of Patients With Multivessel Coronary Artery Disease.FUTURE Trial Investigators.J Am Coll Cardiol. 2021 Nov 9;78(19):1875-1885
# Fearon WF, Zimmermann FM, De Bruyne B et al Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass SurgeryN Engl J Med . 2021 Nov 4. doi: 10.1056/NEJMoa2112299. Online ahead of print.
# Puymirat E, Cayla G, Simon T et al Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction N Engl J Med. 2021 Jul 22;385(4):297-308.,
# Gaudino, M; Hameed, I; Farkouh ME et al, Overall and Cause-Specific Mortality in Randomized Clinical Trials Comparing Percutaneous Interventions With Coronary Bypass Surgery A Meta-analysis; JAMA Intern Med. doi:10.1001/jamainternmed.2020.4748 Published online October 12, 2020.
# Rodríguez-Granillo AM, Fernández-Pereira C, Rodríguez AE.Drug-Eluting vs Bare-Metal Stents for Percutaneous Coronary Intervention. JAMA Intern Med. 2021 Jul 1;181(7):1012-1013. doi: 10.1001/jamainternmed.2021.0030.
# Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018;391:939–48.
# Stone GW, Kappetein AP, Sabik JF et al Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.EXCEL Trial Investigators. N Engl J Med. 2019 Nov 7;381(19):1820-1830
# Park DW, Ahn JM, Yun SC, et al. Ten-year outcomes of stents versus coronary artery bypass grafting for left main coronary artery disease. J Am Coll Cardiol 2018;72 Pt A:2813–22.
# Pavlovsky H, Rodriguez-Granillo AM, Rodriguez AE.Late Mortality After Drug-Eluting, Bare-Metal Stents, and Coronary Bypass Surgery in Left Main Disease. J Am Coll Cardiol. 2019 Apr 9;73(13):1737
# Holm NR, Mäkikallio T, Lindsay MM et al NOBLE investigators. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet. 2020 Jan 18;395(10219):191-
# Daemen J, Boersma E, Flather M et al Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: a meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials. Circulation. 2008 Sep 9;118(11):1146-54.
# Flather M, Rhee JW, Boothroyd DB et al The effect of age on outcomes of coronary artery bypass surgery compared with balloon angioplasty or bare-metal stent implantation among patients with multivessel coronary disease. A collaborative analysis of individual patient data from 10 randomized trials.J Am Coll Cardiol. 2012 Nov 20;60(21):2150-7.
# Pilgrim T, Piccolo R, Heg D et al Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial Lancet. 2018 Sep 1;392(10149):737-746.
# Hironori H, Masafumi On, Hideyuki K, et al Impact of stent length and diameter on 10-year mortality in the SYNTAXES trial Catheter Cardiovasc Interv . 2021 Sep;98(3):E379-E387.
# Gomes WJ, Albuquerque LC, Jatene FB, Leal JCF, Rocha EAV, Almeida RMS.The transfiguration of the EXCEL trial: exceeding ethical and moral boundaries.Eur J Cardiothorac Surg. 2020 Jul 1;58(1):30-34.
# Fearon WF, Zimmermann FM, De Bruyne B et al; FAME 3 Investigators.Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. N Engl J Med. 2021 Nov 4. doi: 10.1056/NEJMoa2112299.
# Sabatine M, Bergmark B, Murphy S et al Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis Lancet. 2021 Dec 18;398(10318):2247-2257.
# Gaudino M, Hameed I, Di Franco A, Naik A, Demetres M, Biondi-Zoccai G, Bangalore S. Comparison of SYNTAX score strata effects of percutaneous and surgical revascularization trials: A meta-analysis J Thorac Cardiovasc Surg. 2021 Jun 2:S0022-5223(21)00881-3
# Piccolo R, Bonaa KH, Efthimiou O et al Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left Main Coronary Artery Revascularization. Coronary Stent Trialists’ (CST) Collaboration. J Am Heart Assoc. 2021 Oct 19;10(20):e018828
# Correa-Sadouet C, Rodríguez-Granillo AM, Gallardo C et al; ORCA investigators. Randomized comparison between bare-metal stent plus colchicine versus drug-eluting stent alone in prevention of clinical adverse events after percutaneous coronary intervention. Protocol Future Cardiol. 2021 Jul;17(4):539-547
# Piccolo R, Bonaa KH, Efthimiou O, et al Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.Coronary Stent Trialists’ Collaboration.Lancet. 2019 Jun 22;393(10190):2503-25
# Zhang JJ, Ye F, Xu K, Kan J et al Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. Eur Heart J. 2020 Jul 14;41(27):2523-2536
# Mieres J, Rodríguez AE, Fernández-Pereira C, Ascarrunz-Cattoretti D.Increased incidence of serious late adverse events with drug-eluting stents when compared with coronary artery bypass surgery: a cause of concern. Future Cardiol. 2020 Nov;16(6):711-723
# Valgimigli M, Campo G, Percoco et al; Multicentre Evaluation of Single High-Dose Bolus Tirofiban vs Abciximab With Sirolimus-Eluting Stent or Bare Metal Stent in Acute Myocardial Infarction Study (MULTISTRATEGY) Investigators.JAMA. 2008 Apr 16;299(15):1788-99
# Writing Committee Members, Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines J Am Coll Cardiol. 2021 Dec 7:S0735-1097(21)06157-X
# Deftereos SG, Beerkens FJ, Shah B et alColchicine in Cardiovascular Disease: In-Depth Review. Circulation. 2022 Jan 4;145(1):61-78. doi: 10.1161/CIRCULATIONAHA.121.056171.
# Matsumura-Nakano Y , Shiomi H, Morimoto T et alComparison of Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting Among Patients With Three-Vessel Coronary Artery Disease in the New-Generation Drug-Eluting Stents Era (From CREDO-Kyoto PCI/CABG Registry Cohort-3) Am J Cardiol . 2021 Apr 15;145:25-36. doi: 10.1016/j.amjcard.2020.12.076.
# Toya T, Sara JD, Corban MT, Taher R et al Assessment of peripheral endothelial function predicts future risk of solid-tumor cancer Eur J Prev Cardiol. 2020 Apr;27(6):608-618.
# Abdul-Jawad Altisent,, Renier Goncalves-Ramírez L,Leticia Fernández et al Long-term Intra-coronary Structural and Vasomotor Assessment of the Absorb Bioresorbable Vascular Scaffold Am J of Cardiol Am J Cardiol. 2022 Jan 17;S0002-9149(21)01268-6. doi: 10.1016/j.amjcard.2021.12.037.
# Rajendran P, RengarajanT, Thangavel J et al The Vascular Endothelium and Human Diseases
International Journal of Biological Sciences 2013; 9(10):1057-1069
# Sidhu MS, Alexander KP, Huang Z et al Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial Originally published12 Nov 2020Circulation. 2020;142:A13030
# . Lopez-Sendon JL, Cyr DD, Mark DB et al Effects of initial invasive vs. initial conservative treatment strategies on recurrent and total cardiovascular events in the ISCHEMIA trial. Eur Heart J 2022;43:148–149.
# Rodriguez AE,Fernandez-Pereira C, Mieres J and A.Matias Rodriguez-Granillo Is non cardiac death increased with an initial invasive revascularization strategy? Commentary on the ISCHEMIA trial European Heart Journal Open (2022) 00, 1–2 https://doi.org/10.1093/ehjopen/oeac012
Read More -
Programa definitivo del Simposio CECI XXI
Jueves 18 de Octubre 18-21:00 hs
Intervencionismo Cardíaco para el Cardiólogo y el Medico Clínico
1- Modulo Cardiopatías Estructurales
18-18:01 hs Palabras de Bienvenida
18:01-18:07 Caso Clínico Clínica Medica OTA
18.07-18:10 Discusión
18.10-18:17 Caso Clínico Cardiología OTA
18.17-18:20 Discusión
18:20-18:35 Estado Actual del Implante valvular aórtico percutáneo.
Prof Lars Sondergaard Dinamarca
18:35 -18:42 Caso Clínico Cardiología Hospital de Clínicas
18:42-18:45 Discusión
18:45-19:10 Mesa de Discusión: Dr Pedro Wainer, Dr Sandra Swieszkowski , Dra Valeria Curotto, Dr Hector Vetulli, Dr Miguel Rosales , Dr Fernando Dettori ,Eduardo Gabe, Dr Jorge Restagno, Cristiano Stummer, Dr Gustavo Allende, Dr Santiago Florit.
19:10-19:17 Caso Clínico Clínica Medica OTA
19:17-19:20 Discusión
19:20-19:30 Cierre percutáneo de orejuela izquierda en pts con alto riesgo de sangrado
Dr Anibal Damonte19:30-19:45 Break
2-Modulo Enfermedad Coronaria
19:45-19: 52 Caso Clínico Hospital de Clínicas
Read More
19:52-19:55 Discusión
19:55-20:10 PCI en pacientes con Angina Estable
Prof Adnan Kastrati FESC FACC
20:10-20:15 Limitaciones del Estudio ORBITA
Dr Alfredo E Rodriguez MD, PhD, FACC, FSCAI
20:15-20:22 Caso Clínico Clínica Medica OTA
20:12-20:15 Discusión
20:22-20:35 Angioplastia primaria en pacientes con enfermedad de múltiples vasos.
Prof Adnan Kastrati FESC FACC
20:35-20:50 Discusión
Ricardo Perez de la Hoz, Carlos Fernandez Pereira, Guillermo Martino, Dr Juan Mieres, Omar Santaera, Dr Carlos Rodriguez Pagani, Dr Miguel Rosales , Dr Fernando Dettori, Dr Carlos Mauvecin
20:50-20:57 Caso Clínico Cardiología Otamendi
20:57-21:00 Discusión
21-22 Cierre y Cocktail -
CECI 2022
Como todos los años, El Centro de estudios en cardiología intervencionista realizo su Simposio Anual, se llevó cabo en el auditorio del Sanatorio Otamendi el día 18 de Noviembre de 17 a 21:30hs.
podrá verlo en este link
Programa CECI 2022
Módulo Estructural 17:05 a 18:30
Moderadores Dr Carlos Fernandez-Pereira, Dr Ricardo Perez de la Hoz.
17:05-17:20 Estado actual de la evidencia de TAVI en estenosis aórtica con riesgo bajo e intermedio.
Dr. Ron Waksman.
17:20-17:30 La relación con la alteración de la conducción AV durante y después del TAVI
Dr. Héctor Vetulli
17:30-17:40 Angioplastia coronaria y TAVI: antes, durante o posterior
Dr.Juan Mieres
17:40-17:55 Casos enlatados de TAVI Vita Flow.
Dr.Carlos Fernandez-Pereira, Hernán Pavlovsky, Dr.Diego Ascarrunz
17:55-18:05 Single,double or triple DAPT post TAVI
Dr. Matías Rodriguez Granillo
18:05-18:20 TAVI en válvula aórtica bicúspide e insuficiencia aórtica: Evidencia clínica.
Dr.Ron Waksman
18:20-18:30 Panel de Discusión. Dr.Eduardo Carrasco ,Dr Hernan Pavlovsky, Dr Camila Gallardo, Dr Federico Vigo, Dra Lucia Fontana.
18:30-18:45 Break
Módulo SCA 18:45 a 20
Moderador: Dr Dario Vita – Dr Matías Rodriguez Granillo
18:45-19:00 DAPT en pacientes con alto riesgo de sangrado
Dr Peter Smits.
19:00-19:15 Evidencia clínica de prasugrel/ticagrelor en pacientes post PCI
Dr Adnan Kastrati.
19:15-19:25 Evidencia clínica de DAPT en pacientes con STEMI y alto riesgo de sangrado
Dr Peter Smits.
19:25-19:35 ¿Clopidogrel debería ser la nueva aspirina en el mantenimiento de la terapia, luego de un SCA?.
Dr Ernesto Duronto.
19:35-19:45 IAM con Múltiples Vasos: La Revascularización «más completa» incluye a la Prevención Secundaria.
Dr Gustavo Samaja.
19:45-20:00 Panel de Discusión :
Dra Bibiana Rubilar- Dr Gaston Procopio- Dra Sandra Swieszkowski, Consejo de
Cardiología Clínica.
Módulo Enfermedad Coronaria 20:00 a 21:30
Moderador: Dra Valeria Curotto – Dra Carolina Salvatori.
20:00-20:10 Rol de las imágenes cardiovasculares, RMN y TMC, en la estratificación de los pacientes coronarios.
Dr. Fernando Dettori
20:10-20:20 Revascularización en pacientes con FEVI deteriorada; estado de la evidencia actual
Dr Jorge Thierer.
20:20-20:30 Porque debemos hacer angioplastia en pacientes crónicos y con deterioro de la función ventricular izquierda después del ISCHEMIA y REVIVED?
Dr Alfredo Rodriguez .
20:30-20:45 Ventajas de la combinación de drogas en los stents liberadores de fármacos para prevención de eventos adversos en población general y en diabéticos
Dr Adnan Kastrati .
20:45-20:55 Podemos usar corta DAPT en pacientes de complejidad media o alta?
Dr Peter Smits
20:55-21:10 Presentación de Casos clínicos.
Dra Giuliana Tresenza
21:10- 21:30 Panel de Discusión.Dr Miguel Rubio,Dr Ruben Piraino, Dr Camila Correa,Dr Carlos Rodriguez Pagani ,Dr Miguel Rosales.
Break y Cena.
Read More -
Personalidad destacada en las ciencias médicas
El director del CECI, el doctor Alfredo Eduardo Rodriguez, ha sido distinguido el viernes 10 de agosto como «Personalidad Destacada de la Ciudad Autónoma de Buenos Aires en el Ámbito de las Ciencias Médicas» en la Legislatura Porteña. El acto se llevó a cabo en el salón San Martín, al que asistieron colegas, pacientes, familiares y amigos del homenajeado.
El doctor Rodriguez fue reconocido por su valioso aporte a la medicina, su trayectoria y calidad humana. Pronunciaron unas palabras en la ceremonia el doctor Francisco Ayala, profesor titular de Medicina y Cardiología en la Universidad de Chile, el doctor Carlos Fernández Pereira, subdirector del CECI, y Agustina Rodriguez Granillo, hija del doctor Rodriguez.¡Felicitaciones!
Read More -
Caso en Vivo desde el Congreso CIT 2018
En el meeting llevado a cabo en Suzhou, con motivo del China International Therapeutics (CIT 2018), en conjunto con TCT, un caso realizado por el Dr Alfredo E. Rodriguez fue transmitido en vivo desde el First Hospital de Nanjing, China.
Se trató de una lesión en bifurcación de Tronco de Coronaria Izquierda no protegido. En esta ocasión, luego de una evaluación con IVUS y preparación con «cutting balloon», se implantó un stent farmacológico Firehawk con polímero bioabsorbible y técnica final de POT en el tronco y ostium de la arteria DA.
Read More
-
Programa de Fellowship
FellowshipInformación generalEl sistema de fellowship en Cardiología Intervencionista en el Sanatorio Otamendi es un programa de 3 años, organizada bajo la dirección del Dr. Alfredo E. Rodríguez. Durante los tres años de la formación del medico cardiólogo se espera que dominen las técnicas implicadas en la intervención coronaria, además del desarrollo de criterio médico sobre el riesgo de procedimientos y beneficios, selección de pacientes y toma de decisiones clínicas en el cuidado del paciente cardiovascular. Al final de este proceso, los médicos formados deberán funcionar como operadores independientes durante los procedimientos intervencionistas.ObjetivosEl objetivo principal es proporcionar una formación integral en el diagnóstico y el tratamiento endovascular de los pacientes con enfermedad cardiovascular. Los beneficiados por este programa estarán en condiciones de asumir posiciones de liderazgo en el campo de la Cardiología Intervencionista. El programa ofrece la oportunidad de adquirir experiencia en los siguientes procedimientos (pero no limitados) a:- Angioplastia coronaria transluminal percutánea
- Angioplastia con balón de cutting balloon
- Angioplastia con balón de liberación de drogas
- Stents farmacológicos de tercera generación
- Aterectomía rotacional
- Trombectomia mecánica y reolítica
- Ecografía intravascular e histología virtual
- Tomografía de coherencia óptica
- Dispositivos de protección distal
Adicional a las técnicas de aprendizaje para la intervención coronaria, los fellows participaran activamente en intervenciones cardíacas no coronarias y el manejo de la enfermedad vascular periférica.Las intervenciones no coronarias incluyen:- Valvuloplastia percutánea aortica y mitral
- Reemplazo percutáneo de la válvula aortica .
- Cierre de las comunicaciones intracardíacas (CIA ,FOP , PDA, CIV)
- Ablación septal de la miocardiopatía hipertrófica obstructiva
- Tratamiento del tromboembolismo pulmonar.
Evaluaciones diagnosticas y tratamiento percutáneo de la enfermedad arterial en:- Carótida
- Subclavia
- Renal
- Aorta torácica y abdominal
- Mesentérica
- Miembros inferiores
-
Quienes Somos
Director
Dr. Alfredo Rodríguez, PhD, FACC, FSCAI, IAGS cv
https://en.wikipedia.org/wiki/Alfredo_E._Rodr%C3%ADguez
Director del Centro de Estudios en Cardiología Intervencionista
Jefe del Departamento de Cardiología Intervencionista
Sanatorio Otamendi y Miroli
Ciudad de Buenos Aires, Argentina
Jefe del Departamento de Cardiología Intervencionista
Sanatorio Las Lomas
San Isidro, provincia de Buenos Aires, Argentina.
Consultores
Prof. David Antoniucci MD,
Jefe de Cardiología Hosiptal Carreggi
Florencia, Italia
Prof. Igor Palacios, MD, FACC
Director de Cardiología Intervencionista
Massachusetts General Hospital
Boston, USA
Staff
Dr. Carlos Fernández Pereira, PhD, FACC, FSCAI
Sanatorio Otamendi y Miroli
Clínica IMADr. Juan Mieres
Sanatorio Otamendi y Miroli
Sanatorio Las LomasDr. Hernan Pavlovsky
Sanatorio Otamendi y Miroli
Clínica IMACoordinador de Investigación Clínica
Dr. A. Matías Rodríguez Granillo
Departmento de Radiología
Lic.Yasmin Navarro
Lic. Dario Rojas
Programa de Fellowship
Dr. Diego Ascarrunz
Dr. A. Matías Rodríguez Granillo
Dr. Francisco Carvajal
Dr. Jorge Restaino
Secretaría
Anabel Chesini
(Centro de Estudios en Cardiología Intervencionista)
Claudia Masclef
(Sanatorio Otamendi y Miroli)
Mariela Gomez
(Sanatorio Las Lomas)
Josefina Herrera
(Clínica IMA)
Read More -
Profesionales
Si es usted médico y quiere contactarse con nosotros comuníquese al (+54) (11) 4962-9012 / 49648721 o por mail aachesini@centroceci.com.ar
Programa de formación de médicos especialistas en Cardiología IntervencionistaRead MoreFellowshipInformación generalEl sistema de fellowship en Cardiología Intervencionista en el Sanatorio Otamendi es un programa de 3 años, organizada bajo la dirección del Dr. Alfredo E. Rodríguez. Durante los tres años de la formación del medico cardiólogo se espera que dominen las técnicas implicadas en la intervención coronaria, además del desarrollo de criterio médico sobre el riesgo de procedimientos y beneficios, selección de pacientes y toma de decisiones clínicas en el cuidado del paciente cardiovascular. Al final de este proceso, los médicos formados deberán funcionar como operadores independientes durante los procedimientos intervencionistas.ObjetivosEl objetivo principal es proporcionar una formación integral en el diagnóstico y el tratamiento endovascular de los pacientes con enfermedad cardiovascular. Los beneficiados por este programa estarán en condiciones de asumir posiciones de liderazgo en el campo de la Cardiología Intervencionista. El programa ofrece la oportunidad de adquirir experiencia en los siguientes procedimientos (pero no limitados) a:- Angioplastia coronaria transluminal percutánea
- Angioplastia con balón de cutting balloon
- Angioplastia con balón de liberación de drogas
- Stents farmacológicos de tercera generación
- Aterectomía rotacional
- Trombectomia mecánica y reolítica
- Ecografía intravascular e histología virtual
- Tomografía de coherencia óptica
- Dispositivos de protección distal
Adicional a las técnicas de aprendizaje para la intervención coronaria, los fellows participaran activamente en intervenciones cardíacas no coronarias y el manejo de la enfermedad vascular periférica.Las intervenciones no coronarias incluyen:- Valvuloplastia percutánea aortica y mitral
- Reemplazo percutáneo de la válvula aortica .
- Cierre de las comunicaciones intracardíacas (CIA ,FOP , PDA, CIV)
- Ablación septal de la miocardiopatía hipertrófica obstructiva
- Tratamiento del tromboembolismo pulmonar.
Evaluaciones diagnosticas y tratamiento percutáneo de la enfermedad arterial en:- Carótida
- Subclavia
- Renal
- Aorta torácica y abdominal
- Mesentérica
- Miembros inferiores
Las investigaciones clínicas que desarrollamos incluyen el uso de nuevos dispositivos para el tratamiento percutáneo de la enfermedad de las arterias coronarias, intervenciones cardíacas no coronarias, tales como el reemplazo valvular percutáneo, estudios de stents liberadores de fármacos, el tratamiento con células madre en pacientes con miocardiopatia dilatada y nuevas tecnologías de imagen en tomografía coronaria multislice.Los Fellows son responsables de la clínica de los pacientes pre y post estudio de cateterismo. Están involucrados en el cuidado diario de estos pacientes, incluida su evaluación previa. El jefe de servicio participa en rondas diarias en estos pacientes. Todos los casos se discuten en la mañana antes de los procedimientos del día.