Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks
Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI). The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Tre...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2023-10, Vol.82 (16), p.1565-1578 |
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| creator | Yang, Seokhun Kang, Jeehoon Park, Kyung Woo Hur, Seung-Ho Lee, Nam Ho Hwang, Doyeon Yang, Han-Mo Ahn, Hyo-Suk Cha, Kwang Soo Jo, Sang-Ho Ryu, Jae Kean Suh, Il-Woo Choi, Hyun-Hee Woo, Seong-Ill Han, Jung-Kyu Shin, Eun-Seok Koo, Bon-Kwon Kim, Hyo-Soo |
| description | Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI).
The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups
This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization.
Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [ |
| doi_str_mv | 10.1016/j.jacc.2023.07.031 |
| format | Article |
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The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups
This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization.
Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes.
The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2023.07.031</identifier><language>eng</language><publisher>Elsevier Inc</publisher><subject>aspirin ; bleeding ; clopidogrel ; ischemic events ; percutaneous coronary intervention</subject><ispartof>Journal of the American College of Cardiology, 2023-10, Vol.82 (16), p.1565-1578</ispartof><rights>2023 American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c333t-bca3c3fcd978b74307edd4fa14fcc21ff10f2af5aba2c9513574732cd2cfcb0e3</citedby><cites>FETCH-LOGICAL-c333t-bca3c3fcd978b74307edd4fa14fcc21ff10f2af5aba2c9513574732cd2cfcb0e3</cites><orcidid>0000-0003-0847-5329 ; 0000-0002-1548-2351 ; 0000-0002-9169-6968 ; 0000-0002-0016-0747 ; 0000-0002-2063-1542</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S073510972306463X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids></links><search><creatorcontrib>Yang, Seokhun</creatorcontrib><creatorcontrib>Kang, Jeehoon</creatorcontrib><creatorcontrib>Park, Kyung Woo</creatorcontrib><creatorcontrib>Hur, Seung-Ho</creatorcontrib><creatorcontrib>Lee, Nam Ho</creatorcontrib><creatorcontrib>Hwang, Doyeon</creatorcontrib><creatorcontrib>Yang, Han-Mo</creatorcontrib><creatorcontrib>Ahn, Hyo-Suk</creatorcontrib><creatorcontrib>Cha, Kwang Soo</creatorcontrib><creatorcontrib>Jo, Sang-Ho</creatorcontrib><creatorcontrib>Ryu, Jae Kean</creatorcontrib><creatorcontrib>Suh, Il-Woo</creatorcontrib><creatorcontrib>Choi, Hyun-Hee</creatorcontrib><creatorcontrib>Woo, Seong-Ill</creatorcontrib><creatorcontrib>Han, Jung-Kyu</creatorcontrib><creatorcontrib>Shin, Eun-Seok</creatorcontrib><creatorcontrib>Koo, Bon-Kwon</creatorcontrib><creatorcontrib>Kim, Hyo-Soo</creatorcontrib><title>Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks</title><title>Journal of the American College of Cardiology</title><description>Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI).
The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups
This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization.
Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes.
The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)
[Display omitted]</description><subject>aspirin</subject><subject>bleeding</subject><subject>clopidogrel</subject><subject>ischemic events</subject><subject>percutaneous coronary intervention</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kM1O3DAUha2qlTqlfYGuvOyCBP8k40TqZohoOxIIhGBteW6uwUPGDrYHqQ_Ae-Nhuu7qLu75jvQdQr5zVnPGl2fbemsAasGErJmqmeQfyIK3bVfJtlcfyYIp2Vac9eoz-ZLSljG27Hi_IK9D2M0muhQ8DZaufHbzZDJOmOlV8CE_YjSzw0RXNmOkNxhhn43HsE90CDF4E__StS-_FyxwqVkBhDg6_0BzoMPkvAMzndJ1gkfcOTilxo_0fEJ8z9y69JS-kk_WTAm__bsn5P7Xxd3wp7q8_r0eVpcVSClztQEjQVoYe9VtVCOZwnFsrOGNBRDcWs6sMLY1GyOgb7lsVaOkgFGAhQ1DeUJ-HHvnGJ73mLLeuQQ4TUchLTq1XMq-a3iJimMUYkgpotVzdLsiqznTh831Vh8214fNNVO6bF6gn0cIi8SLw6gTOPRQVCNC1mNw_8PfAAGGji0</recordid><startdate>20231017</startdate><enddate>20231017</enddate><creator>Yang, Seokhun</creator><creator>Kang, Jeehoon</creator><creator>Park, Kyung Woo</creator><creator>Hur, Seung-Ho</creator><creator>Lee, Nam Ho</creator><creator>Hwang, Doyeon</creator><creator>Yang, Han-Mo</creator><creator>Ahn, Hyo-Suk</creator><creator>Cha, Kwang Soo</creator><creator>Jo, Sang-Ho</creator><creator>Ryu, Jae Kean</creator><creator>Suh, Il-Woo</creator><creator>Choi, Hyun-Hee</creator><creator>Woo, Seong-Ill</creator><creator>Han, Jung-Kyu</creator><creator>Shin, Eun-Seok</creator><creator>Koo, Bon-Kwon</creator><creator>Kim, Hyo-Soo</creator><general>Elsevier Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0847-5329</orcidid><orcidid>https://orcid.org/0000-0002-1548-2351</orcidid><orcidid>https://orcid.org/0000-0002-9169-6968</orcidid><orcidid>https://orcid.org/0000-0002-0016-0747</orcidid><orcidid>https://orcid.org/0000-0002-2063-1542</orcidid></search><sort><creationdate>20231017</creationdate><title>Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks</title><author>Yang, Seokhun ; Kang, Jeehoon ; Park, Kyung Woo ; Hur, Seung-Ho ; Lee, Nam Ho ; Hwang, Doyeon ; Yang, Han-Mo ; Ahn, Hyo-Suk ; Cha, Kwang Soo ; Jo, Sang-Ho ; Ryu, Jae Kean ; Suh, Il-Woo ; Choi, Hyun-Hee ; Woo, Seong-Ill ; Han, Jung-Kyu ; Shin, Eun-Seok ; Koo, Bon-Kwon ; Kim, Hyo-Soo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c333t-bca3c3fcd978b74307edd4fa14fcc21ff10f2af5aba2c9513574732cd2cfcb0e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>aspirin</topic><topic>bleeding</topic><topic>clopidogrel</topic><topic>ischemic events</topic><topic>percutaneous coronary intervention</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Seokhun</creatorcontrib><creatorcontrib>Kang, Jeehoon</creatorcontrib><creatorcontrib>Park, Kyung Woo</creatorcontrib><creatorcontrib>Hur, Seung-Ho</creatorcontrib><creatorcontrib>Lee, Nam Ho</creatorcontrib><creatorcontrib>Hwang, Doyeon</creatorcontrib><creatorcontrib>Yang, Han-Mo</creatorcontrib><creatorcontrib>Ahn, Hyo-Suk</creatorcontrib><creatorcontrib>Cha, Kwang Soo</creatorcontrib><creatorcontrib>Jo, Sang-Ho</creatorcontrib><creatorcontrib>Ryu, Jae Kean</creatorcontrib><creatorcontrib>Suh, Il-Woo</creatorcontrib><creatorcontrib>Choi, Hyun-Hee</creatorcontrib><creatorcontrib>Woo, Seong-Ill</creatorcontrib><creatorcontrib>Han, Jung-Kyu</creatorcontrib><creatorcontrib>Shin, Eun-Seok</creatorcontrib><creatorcontrib>Koo, Bon-Kwon</creatorcontrib><creatorcontrib>Kim, Hyo-Soo</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yang, Seokhun</au><au>Kang, Jeehoon</au><au>Park, Kyung Woo</au><au>Hur, Seung-Ho</au><au>Lee, Nam Ho</au><au>Hwang, Doyeon</au><au>Yang, Han-Mo</au><au>Ahn, Hyo-Suk</au><au>Cha, Kwang Soo</au><au>Jo, Sang-Ho</au><au>Ryu, Jae Kean</au><au>Suh, Il-Woo</au><au>Choi, Hyun-Hee</au><au>Woo, Seong-Ill</au><au>Han, Jung-Kyu</au><au>Shin, Eun-Seok</au><au>Koo, Bon-Kwon</au><au>Kim, Hyo-Soo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks</atitle><jtitle>Journal of the American College of Cardiology</jtitle><date>2023-10-17</date><risdate>2023</risdate><volume>82</volume><issue>16</issue><spage>1565</spage><epage>1578</epage><pages>1565-1578</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI).
The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups
This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization.
Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes.
The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)
[Display omitted]</abstract><pub>Elsevier Inc</pub><doi>10.1016/j.jacc.2023.07.031</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0003-0847-5329</orcidid><orcidid>https://orcid.org/0000-0002-1548-2351</orcidid><orcidid>https://orcid.org/0000-0002-9169-6968</orcidid><orcidid>https://orcid.org/0000-0002-0016-0747</orcidid><orcidid>https://orcid.org/0000-0002-2063-1542</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Journal of the American College of Cardiology, 2023-10, Vol.82 (16), p.1565-1578 |
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| language | eng |
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| source | Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | aspirin bleeding clopidogrel ischemic events percutaneous coronary intervention |
| title | Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks |
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