XIENCE 28 USA Study

Not Applicable

Completed

Conditions: Thrombocytopenia
Coagulation Disorder
Anemia
Renal Insufficiency
Coronary Artery Disease
Bleeding Disorder
Ischemic Stroke
Hemorrhagic Stroke
Hematological Diseases

Interventions: Device: XIENCE
Drug: DAPT (aspirin and/or P2Y12 receptor inhibitor)

Registration Number: NCT03815175

Lead Sponsor: Abbott Medical Devices

Brief Summary: The XIENCE 28 USA Study is prospective, single arm, multi-center, open label, non-randomized trial to evaluate safety of 1-month (as short as 28 days) dual antiplatelet therapy (DAPT) in subjects at high risk of bleeding (HBR) undergoing percutaneous coronary intervention (PCI) with the approved XIENCE family (XIENCE Xpedition Everolimus Eluting Coronary Stent System \[EECSS\], XIENCE Alpine EECSS and XIENCE Sierra EECSS) of coronary drug-eluting stents.

Detailed Description: The XIENCE 28 USA Study will evaluate the safety of 1-month DAPT following XIENCE implantation in HBR patients. A minimum of 640 to a maximum of 800 subjects will be registered from approximately 50 sites in the United States and Canada. Subject registration is capped at 75 per site. Eligibility of P2Y12 receptor inhibitor discontinuation will be assessed at 1-month follow-up. Subjects who are free from myocardial infarction (MI), repeat coronary revascularization, stroke, or stent thrombosis (ARC definite/probable) within 1 month (prior to 1-month visit but at least 28 days) after stenting AND have been compliant with 1-month DAPT without interruption of either aspirin and/or P2Y12 receptor inhibitor for \> 7 consecutive days are considered as "1-month clear", and will discontinue P2Y12 receptor inhibitor as early as 28 days and continued with aspirin monotherapy through 12-month follow-up.

All registered subjects will be followed at 1, 3, 6 and 12 months post index procedure. The data collected from the XIENCE 28 USA Study will be pooled with the data from the XIENCE 28 Global Study (Protocol # ABT-CIP-10235) to compare with the historical control of non-complex HBR subjects treated with standard DAPT duration of up to 12 months from the XIENCE V USA Study.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1605

Inclusion Criteria

Subject is considered at high risk for bleeding (HBR), defined as meeting one or more of the following criteria at the time of registration and in the opinion of the referring physician, the risk of major bleeding with > 1-month DAPT outweighs the benefit:
1. ≥ 75 years of age.
2. Clinical indication for chronic (at least 6 months) or lifelong anticoagulation therapy
3. History of major bleeding which required medical attention within 12 months of the index procedure.
4. History of stroke (ischemic or hemorrhagic).
5. Renal insufficiency (creatinine ≥ 2.0 mg/dl) or failure (dialysis dependent).
6. Systemic conditions associated with an increased bleeding risk (e.g. hematological disorders, including a history of or current thrombocytopenia defined as a platelet count <100,000/mm3, or any known coagulation disorder associated with increased bleeding risk).
7. Anemia with hemoglobin < 11g/dl.
Subject must be at least 18 years of age.
Subject must provide written informed consent as approved by the Institutional Review Board (IRB) of the respective clinical site prior to any trial related procedure.
Subject is willing to comply with all protocol requirements, including agreement to stop taking P2Y12 inhibitor at 1 month, if eligible per protocol.
Subject must agree not to participate in any other clinical trial for a period of one year following the index procedure, except for cases where subject is transferred to the XIENCE 90 study after the 1-month visit assessment

Angiographic Inclusion Criteria

Up to three target lesions with a maximum of two target lesions per epicardial vessel. Note:
- The definition of epicardial vessels means left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX) and right coronary artery (RCA) and their branches. For example, the subject must not have >2 lesions requiring treatment within both the LAD and a diagonal branch in total.
- If there are two target lesions within the same epicardial vessel, the two target lesions must be at least 15 mm apart per visual estimation; otherwise this is considered as a single target lesion.
Target lesion must be located in a native coronary artery with visually estimated reference vessel diameter between 2.25 mm and 4.25 mm.
Exclusive use of XIENCE family of stent systems during the index procedure.
Target lesion has been treated successfully, which is defined as achievement of a final in-stent residual diameter stenosis of <20% with final TIMI-3 flow assessed by online quantitative angiography or visual estimation, with no residual dissection NHLBI grade ≥ type B, and no transient or sustained angiographic complications (e.g., distal embolization, side branch closure), no chest pain lasting > 5 minutes, and no ST segment elevation > 0.5mm or depression lasting > 5 minutes.

Exclusion Criteria

Subject with an indication for the index procedure of acute ST-segment elevation MI (STEMI).
Subject has a known hypersensitivity or contraindication to aspirin, heparin/bivalirudin, P2Y12 inhibitors (clopidogrel/prasugrel/ticagrelor), everolimus, cobalt, chromium, nickel, tungsten, acrylic and fluoro polymers or contrast sensitivity that cannot be adequately pre-medicated.
Subject with implantation of another drug-eluting stent (other than XIENCE) within 12 months prior to index procedure.
Subject has a known left ventricular ejection fraction (LVEF) <30%.
Subject judged by physician as inappropriate for discontinuation from P2Y12 inhibitor use at 1 month, due to another condition requiring chronic P2Y12 inhibitor use.
Subject with planned surgery or procedure necessitating discontinuation of P2Y12 inhibitor within 1 month following index procedure.
Subject with a current medical condition with a life expectancy of less than 12 months.
Subject intends to participate in an investigational drug or device trial within 12 months following the index procedure. Transferring to the XIENCE 90 study will not be an exclusion criterion.
Pregnant or nursing subjects and those who plan pregnancy in the period up to 1 year following index procedure. Female subjects of child-bearing potential must have a negative pregnancy test done within 7 days prior to the index procedure per site standard test.
Presence of other anatomic or comorbid conditions, or other medical, social, or psychological conditions that, in the investigator's opinion, could limit the subject's ability to participate in the clinical investigation or to comply with follow-up requirements, or impact the scientific soundness of the clinical investigation results.
Subject is currently participating in another clinical trial that has not yet completed its primary endpoint.

Angiographic Exclusion Criteria

Target lesion is in a left main location.
Target lesion is located within an arterial or saphenous vein graft.
Target lesion is restenotic from a previous stent implantation.
Target lesion is a chronic total occlusion (CTO, defined as lesion with TIMI flow 0 for at least 3 months).
Target lesion is implanted with overlapping stents, whether planned or for bailout.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
XIENCE	XIENCE	XIENCE + 1 month DAPT
XIENCE	DAPT (aspirin and/or P2Y12 receptor inhibitor)	XIENCE + 1 month DAPT

Primary Outcome Measures

Name	Time	Method
Percentage of Participants With Composite Rate of All Death or All Myocardial Infarction (MI) (Modified Academic Research Consortium [ARC]), by Propensity Score Quintile	From 1 to 6 months	All death: All deaths are considered cardiac unless an unequivocal non-cardiac cause can be established. Specifically, any unexpected death even in patients with coexisting potentially fatal non-cardiac disease (e.g.cancer, infection) should be classified as cardiac. MI Definition (Modified ARC): Patients present any of the following clinical or imaging evidence of ischemia: * Clinical symptoms of ischemia; * ECG changes indicative of new ischemia - new ST-T changes or new left bundle branch block (LBBB), development of pathological Q waves; * Imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality AND confirmed with elevated cardiac biomarkers per ARC criteria: * Peripheral MI * Spontaneous MI (\> 48h following PCI, \> 72h following CABG): CK-MB \> URL or Troponin \> URL with baseline value \< URL
Percentage of Participants With Composite Rate of All Death or All Myocardial Infarction (Modified ARC), by Propensity Score Quintile	From 1 to 12 months	All death: All deaths are considered cardiac unless an unequivocal non-cardiac cause can be established. Specifically, any unexpected death even in patients with coexisting potentially fatal non-cardiac disease (e.g.cancer, infection) should be classified as cardiac. MI Definition (Modified ARC): Patients present any of the following clinical or imaging evidence of ischemia: * Clinical symptoms of ischemia; * ECG changes indicative of new ischemia - new ST-T changes or new left bundle branch block (LBBB), development of pathological Q waves; * Imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality AND confirmed with elevated cardiac biomarkers per ARC criteria: * Peripheral MI * Spontaneous MI (\> 48h following PCI, \> 72h following CABG): CK-MB \> URL or Troponin \> URL with baseline value \< URL

Secondary Outcome Measures

Name	Time	Method
Number of All Death (Cardiac Death, Vascular Death, Non-cardiovascular Death)	From 1 to 12 months	All Death: All deaths are considered cardiac unless an unequivocal non-cardiac cause can be established. Specifically, any unexpected death even inpatients with coexisting potentially fatal non-cardiac disease (e.g. cancer,infection) should be classified as cardiac. Cardiac death: Any death due to proximate cardiac cause (e.g. MI, low-output failure,fatal arrhythmia), unwitnessed death and death of unknown cause, all procedure related deaths including those related to concomitant treatment. Vascular death: Death due to non-coronary vascular causes such as cerebrovascular disease, pulmonary embolism, ruptured aortic aneurysm, dissecting aneurysm, or other vascular cause. Non-cardiovascular death: Any death not covered by the above definitions such as death caused by infection, malignancy, sepsis, pulmonary causes, accident, suicide or trauma.
Percentage of Participants With Major Bleeding Rate (Bleeding Academic Research Consortium [BARC] Type 2-5), by Propensity Score Quintiles	From 1 to 6 months	Bleeding per Bleeding Academic Research Consortium (BARC) adjudicated definitions: * Type 2: Any overt, actionable sign of hemorrhage * Type 3a: Overt bleeding plus Hb drop of 3 to \< 5g/dL;Any transfusion with overt bleeding * Type 3b: Overt bleeding plus Hb drop ≥ 5 g/dL;Cardiac tamponade;Bleeding requiring surgical intervention for control;Bleeding requiring IV vasoactive agents * Type 3c: Intracranial hemorrhage; Subcategories confirmed by autopsy/imaging/lumbar puncture;Intraocular bleed compromising vision * Type 4: CABG-related bleeding: Perioperative intracranial bleeding within 48h;Reoperation after closure of sternotomy for the purpose of controlling bleeding;Transfusion of ≥ 5 U whole blood/packed red blood cells within a 48h period;Chest tube output ≥ 2L within 24-h period * Type 5: Fatal bleeding * Type 5a: Probable fatal bleeding;no autopsy/imaging confirmation but clinically suspicious * Type 5b: Definite fatal bleeding;overt bleeding/autopsy/imaging confirmation
Percentage of Participants With Major Bleeding Rate (BARC Type 2-5), by Propensity Score Quintiles	From 1 to 12 months	Bleeding per Bleeding Academic Research Consortium (BARC) adjudicated definitions: * Type 2: Any overt, actionable sign of hemorrhage * Type 3a: Overt bleeding plus Hb drop of 3 to \< 5g/dL;Any transfusion with overt bleeding * Type 3b: Overt bleeding plus Hb drop ≥ 5 g/dL;Cardiac tamponade;Bleeding requiring surgical intervention for control;Bleeding requiring IV vasoactive agents * Type 3c: Intracranial hemorrhage; Subcategories confirmed by autopsy/imaging/lumbar puncture;Intraocular bleed compromising vision * Type 4: CABG-related bleeding: Perioperative intracranial bleeding within 48h;Reoperation after closure of sternotomy for the purpose of controlling bleeding;Transfusion of ≥ 5 U whole blood/packed red blood cells within a 48h period;Chest tube output ≥ 2L within 24-h period * Type 5: Fatal bleeding * Type 5a: Probable fatal bleeding;no autopsy/imaging confirmation but clinically suspicious * Type 5b: Definite fatal bleeding;overt bleeding/autopsy/imaging confirmation
Number of Participants With Stent Thrombosis (ARC Definite/Probable, ARC Definite)	From 1 to 12 months	Definite stent thrombosis: Definite stent thrombosis is considered to have occurred by either angiographic or pathologic confirmation. Probable stent thrombosis: Clinical definition of probable stent thrombosis is considered to have occurred after intracoronary stenting in the following cases: * Any unexplained death within the first 30 days * Irrespective of the time after the index procedure, any MI that is related to documented acute ischemia in the territory of the implanted stent without angiographic confirmation of stent thrombosis and in the absence of any other obvious cause
Number of Participants With All Myocardial Infarction (MI) and MI Attributed to Target Vessel (TV-MI, Modified ARC)	From 1 to 6 months	All Myocardial Infarction (Modified ARC): Patients present any of the following clinical or imaging evidence of ischemia: * Clinical symptoms of ischemia; * ECG changes indicative of new ischemia - new ST-T changes or new left bundle branch block (LBBB), development of pathological Q waves; * Imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality) AND confirmed with elevated cardiac biomarkers per ARC criteria: * Periprocedural MI: * Within 48h after PCI: CK-MB \>3 x URL or Troponin \> 3 x URL with baseline value \< URL * Within 72h after CABG: CK-MB \>5 x URL or Troponin \> 5 x URL with baseline value \< URL * Spontaneous MI (\> 48h following PCI, \> 72h following CABG): CK-MB \> URL or Troponin \> URL with baseline value \< URL TV-MI: All infarcts that cannot be clearly attributed to a vessel other than the target vessel will be considered related to the target vessel.
Number of Participants With All MI and MI Attributed to Target Vessel (TV-MI, Modified ARC)	From 1 to 12 months	All Myocardial Infarction (Modified ARC): Patients present any of the following clinical or imaging evidence of ischemia: * Clinical symptoms of ischemia; * ECG changes indicative of new ischemia - new ST-T changes or new left bundle branch block (LBBB), development of pathological Q waves; * Imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality) AND confirmed with elevated cardiac biomarkers per ARC criteria: * Periprocedural MI: * Within 48h after PCI: CK-MB \>3 x URL or Troponin \> 3 x URL with baseline value \< URL * Within 72h after CABG: CK-MB \>5 x URL or Troponin \> 5 x URL with baseline value \< URL * Spontaneous MI (\> 48h following PCI, \> 72h following CABG): CK-MB \> URL or Troponin \> URL with baseline value \< URL TV-MI: All infarcts that cannot be clearly attributed to a vessel other than the target vessel will be considered related to the target vessel.
Number of Participants With Composite of Cardiac Death or MI (Modified ARC)	From 1 to 12 months	Cardiac death: Any death due to proximate cardiac cause (e.g. MI, low-output failure,fatal arrhythmia), unwitnessed death and death of unknown cause, all procedure related deaths including those related to concomitant treatment. MI (Modified ARC): Patients present any of the following clinical or imaging evidence of ischemia: * Clinical symptoms of ischemia; * ECG changes indicative of new ischemia - new ST-T changes or new left bundle branch block (LBBB), development of pathological Q waves; * Imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality AND confirmed with elevated cardiac biomarkers per ARC criteria: * Periprocedural MI: * Within 48h after PCI: CK-MB \>3 x URL or Troponin \> 3 x URLwith baseline value \< URL * Within 72h after CABG: CK-MB \>5 x URL or Troponin \> 5 x URL with baseline value \< URL * Spontaneous MI (\> 48h following PCI, \> 72h following CABG): CK-MB \> URL or Troponin \> URL with baseline value \< URL
Number of Participants With Composite of All Death or All MI (Modified ARC)	From 1 to 12 months	All death: All deaths are considered cardiac unless an unequivocal non-cardiac cause can be established. Specifically, any unexpected death even in patients with coexisting potentially fatal non-cardiac disease (e.g.cancer, infection) should be classified as cardiac. MI (Modified ARC): Patients present any of the following clinical or imaging evidence of ischemia: * Clinical symptoms of ischemia; * ECG changes indicative of new ischemia - new ST-T changes or new left bundle branch block (LBBB), development of pathological Q waves; * Imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality) AND confirmed with elevated cardiac biomarkers per ARC criteria: * Periprocedural MI * Spontaneous MI (\> 48h following PCI, \> 72h following CABG): CK-MB \> URL or Troponin \> URL with baseline value \< URL
Number of Participants With All Stroke (Ischemic Stroke and Hemorrhagic Stroke)	From 1 to 12 months	An acute symptomatic episode of neurological dysfunction attributed to a vascular cause lasting more than 24 hours or lasting 24 hours or less with a brain imaging study or autopsy showing new infarction. * Ischemic Stroke: An acute symptomatic episode of focal cerebral, spinal, or retinal dysfunction caused by an infarction of central nervous system tissue. * Hemorrhagic Stroke: An acute symptomatic episode of focal or global cerebral or spinal dysfunction caused by a non-traumatic intraparenchymal, intraventricular, or subarachnoid hemorrhage. * Undetermined Stroke: A stroke with insufficient information to allow categorization as ischemic or hemorrhagic. * Pharmacologic, i.e., thrombolytic drug administration, or Non-pharmacologic, i.e., neurointerventional procedure (e.g., intracranial angioplasty)
Number of Participants With Clinically-indicated Target Lesion Revascularization (CI-TLR)	From 1 to 6 months	Target Lesion Revascularization (TLR) is defined as any repeat percutaneous intervention of the target lesion or bypass surgery of the target vessel performed for restenosis or other complication of the target lesion. All TLR should be classified prospectively as clinically indicated \[CI\] or not clinically indicated by the investigator prior to repeat angiography. Clinically Indicated \[CI\] Revascularization: A revascularization is considered clinically indicated if angiography at follow-up shows a percent diameter stenosis ≥ 50% and if one of the following occurs: * A positive history of recurrent angina pectoris, presumably related to the target vessel; * Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; * Abnormal results of any invasive functional diagnostic test * A TLR/TVR with a diameter stenosis ≥70% in the absence of the above mentioned ischemic signs or symptoms.
Number of Participants With CI-TVR	From 1 to 12 months	TVR is defined as any repeat percutaneous intervention or surgical bypass of any segment of the target vessel. The target vessel is defined as the entire major coronary vessel proximal and distal to the target lesion which includes upstream and downstream branches and the target lesion itself. A revascularization is considered clinically indicated if angiography at follow-up shows a percent diameter stenosis ≥ 50% and if one of the following occurs: * A positive history of recurrent angina pectoris, presumably related to the target vessel; * Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; * Abnormal results of any invasive functional diagnostic test (e.g.,Doppler flow velocity reserve, fractional flow reserve); * A TVR with a diameter stenosis ≥70% in the absence of the above mentioned ischemic signs or symptoms.
Number of Participants With Target Lesion Failure (TLF, Composite of Cardiac Death, TV-MI and CI-TLR)	From 1 to 12 months	TLF is defined as a composite of all cardiac death, myocardial infarction attributed to target vessel or clinically-indicated TLR.
Number of Participants With Target Vessel Failure (TVF, Composite of Cardiac Death, TV-MI and CI-TVR)	From 1 to 12 months	TVF is defined as a composite of cardiac death, MI attributed to target vessel, clinically-indicated TLR, or clinically-indicated TVR, non-TLR.
Number of Participants With Major Bleeding Defined by the Bleeding Academic Research Consortium (BARC) Type 3-5	From 1 to 12 months	Bleeding per Bleeding Academic Research Consortium (BARC) adjudicated definitions are as follows: * Type 3a: Overt bleeding plus Hemoglobin(Hb) drop of 3 to \< 5 g/dL; Any transfusion with overt bleeding * Type 3b: Overt bleeding plus Hb drop ≥ 5 g/dL; Cardiac tamponade; Bleeding requiring surgical intervention for control; Bleeding requiring IV vasoactive agents * Type 3c: Intracranial hemorrhage;Subcategories confirmed by autopsy or imaging or lumbar puncture; Intraocular bleed compromising vision * Type 4: CABG-related bleeding: Perioperative intracranial bleeding within 48 h; Reoperation after closure of sternotomy for the purpose of controlling bleeding; Transfusion of ≥ 5 U whole blood or packed red blood cells within a 48-h period; Chest tube output ≥ 2L within a 24-h period * Type 5: Fatal bleeding * Type 5a: Probable fatal bleeding; no autopsy/imaging confirmation but clinically suspicious * Type 5b: Definite fatal bleeding;overt bleeding/autopsy or imaging confirmation
Number of Participants With CI-TLR	From 1 to 12 months	Target Lesion Revascularization (TLR) is defined as any repeat percutaneous intervention of the target lesion or bypass surgery of the target vessel performed for restenosis or other complication of the target lesion. All TLR should be classified prospectively as clinically indicated \[CI\] or not clinically indicated by the investigator prior to repeat angiography. Clinically Indicated \[CI\] Revascularization: A revascularization is considered clinically indicated if angiography at follow-up shows a percent diameter stenosis ≥ 50% and if one of the following occurs: * A positive history of recurrent angina pectoris, presumably related to the target vessel; * Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; * Abnormal results of any invasive functional diagnostic test * A TLR/TVR with a diameter stenosis ≥70% in the absence of the above mentioned ischemic signs or symptoms.
Number of Participants With Clinically-indicated Target Vessel Revascularization (CI-TVR)	From 1 to 6 months	TVR is defined as any repeat percutaneous intervention or surgical bypass of any segment of the target vessel. The target vessel is defined as the entire major coronary vessel proximal and distal to the target lesion which includes upstream and downstream branches and the target lesion itself. A revascularization is considered clinically indicated if angiography at follow-up shows a percent diameter stenosis ≥ 50% and if one of the following occurs: * A positive history of recurrent angina pectoris, presumably related to the target vessel; * Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; * Abnormal results of any invasive functional diagnostic test (e.g.,Doppler flow velocity reserve, fractional flow reserve); * A TVR with a diameter stenosis ≥70% in the absence of the above mentioned ischemic signs or symptoms.

Trial Locations

Locations (111): Clearwater Cardiovascular Consultants
🇺🇸
Clearwater, Florida, United States
Charleston Area Medical Center
🇺🇸
Charleston, West Virginia, United States
Allegheny General Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Massachusetts General Hospital
🇺🇸
Boston, Massachusetts, United States
Medisch Centrum Leeuwarden
🇳🇱
Leeuwarden, Friesld, Netherlands
Ziekenhuis Oost-Limburg
🇧🇪
Genk, Limburg, Belgium
Queen Elizabeth Hospital
🇭🇰
Hong Kong, Hong Kong
Royal Jubilee Hospital
🇨🇦
Victoria, British Columbia, Canada
Saint John Regional Hospital - New Brunswick Heart Centre
🇨🇦
Saint John, New Brunswick, Canada
Santa Maria Hospital
🇵🇹
Lisboa, Lisbon, Portugal
Taipei Veterans General Hospital (VGH)
🇨🇳
Taipei, Ntaiwan, Taiwan
Lenox Hill Hospital
🇺🇸
New York, New York, United States
Kepler Universitätsklinikum GmbH
🇦🇹
Linz, Upr Aus, Austria
NEA Baptist Clinic
🇺🇸
Jonesboro, Arkansas, United States
Scottsdale Healthcare Shea
🇺🇸
Scottsdale, Arizona, United States
Cone Health Medical Group Heartcare
🇺🇸
Greensboro, North Carolina, United States
Union Memorial Hospital
🇺🇸
Baltimore, Maryland, United States
Presbyterian Medical Center (PA)
🇺🇸
Philadelphia, Pennsylvania, United States
East Tennessee Heart Consultants
🇺🇸
Knoxville, Tennessee, United States
Mission Cardiovascular Research Institute
🇺🇸
Fremont, California, United States
Huntington Memorial Hospital
🇺🇸
Pasadena, California, United States
Arkansas Heart Hospital
🇺🇸
Little Rock, Arkansas, United States
Heart Center Research, LLC
🇺🇸
Huntsville, Alabama, United States
Cardiology Associates of Fairfield County, PC
🇺🇸
Norwalk, Connecticut, United States
Cardiovascular Research Institute of Kansas
🇺🇸
Wichita, Kansas, United States
Redmond Regional Medical Center
🇺🇸
Rome, Georgia, United States
Kaiser Permanente - Santa Clara
🇺🇸
Santa Clara, California, United States
Mount Sinai Hospital
🇺🇸
New York, New York, United States
Via Christi Regional Medical Center - St. Francis Campus
🇺🇸
Wichita, Kansas, United States
Jersey Shore University Medical Center
🇺🇸
Neptune, New Jersey, United States
St. Joseph's Hospital Health Center
🇺🇸
Syracuse, New York, United States
Beth Isreal Deaconess Medical Center
🇺🇸
Boston, Massachusetts, United States
UPMC Hamot
🇺🇸
Erie, Pennsylvania, United States
St. Joseph Medical Center
🇺🇸
Reading, Pennsylvania, United States
National Taiwan University Hospital
🇨🇳
Taipei, NTaiwan, Taiwan
UZ Gent
🇧🇪
Gent, Flemish, Belgium
Foothills Medical Centre
🇨🇦
Calgary, Alberta, Canada
Albert Schweitzer Ziekenhuis Albert Schweitzerplaats
🇳🇱
Dordrecht, Zuid, Netherlands
Hospital Clinico Universitario de Valladolid
🇪🇸
Valladolid, Cstleon, Spain
Hopital du Sacre-Coeur de
🇨🇦
Montréal, Quebec, Canada
Luzerner Kantonsspital
🇨🇭
Luzern, Switzerland
Kaohsiung Chang Gung Memorial Hospital
🇨🇳
Kaohsiung, STailwan, Taiwan
Herzzentrum Leipzig GmbH04289
🇩🇪
Leipzig, Saxony, Germany
The Second Hospital of Jilin University
🇨🇳
Changchun, N China, China
Az.Osp. Universitaria di Ferrara
🇮🇹
Cona, Emi-rom, Italy
Istituto Clinico Humanitas
🇮🇹
Rozzano, Lombard, Italy
Beijing AnZhen Hospital
🇨🇳
Beijing, Beijing, China
Hospital Clinic I Provincial de Barcelona
🇪🇸
Barcelona, Catalon, Spain
Freeman Hospital
🇬🇧
High Heaton, Newcastle Upon Tyne, United Kingdom
Kantonsspital Aarau
🇨🇭
Aarau, Basel, Switzerland
National Heart Centre
🇸🇬
Singapore, Central Singapore, Singapore
HCU Virgen de la Victoria Campus Universitario de Teatinos
🇪🇸
Málaga, Andalu, Spain
Institute de Cardiologie de Montreal (Montreal Heart Inst.)
🇨🇦
Montréal, Quebec, Canada
Elisabeth-Krankenhaus Essen GmbH
🇩🇪
Essen, N. Rhin, Germany
Tan Tock Seng Hospital
🇸🇬
Singapore, Singapore Central, Singapore
Segeberger Kliniken GmbH Am Kurpark 1
🇩🇪
Bad Segeberg, Schlesw, Germany
Center Inselspital Bern
🇨🇭
Bern, Switzerland
Scheperziekenhuis Boermarkeweg
🇳🇱
Emmen, Drenthe, Netherlands
Hospital Alvaro Cunqueiro
🇪🇸
Vigo, Pontev, Spain
University Hospital of Wales
🇬🇧
Cardiff, Wales, United Kingdom
Craigavon Area Hospital
🇬🇧
Portadown, Nirelnd, United Kingdom
Chang Gung Memorial Hospital
🇨🇳
Linkou, NTaiwan, Taiwan
Hospital Universitario Doce de Octubre
🇪🇸
Madrid, Spain
AOU Federico II - Università degli Studi di Napoli
🇮🇹
Napoli, Campani, Italy
Policlinico Universitario A. Gemelli
🇮🇹
Roma, Latium, Italy
Centro Cardiologico Monzino
🇮🇹
Milano, Lombard, Italy
UKE Hamburg (Universitatsklinik Eppendorf)
🇩🇪
Hamburg, Germany
Minneapolis Heart Institute
🇺🇸
Minneapolis, Minnesota, United States
Phoenix Cardiovascular Research Group
🇺🇸
Phoenix, Arizona, United States
Centennial Medical Center
🇺🇸
Nashville, Tennessee, United States
Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Morton Plant Hospital
🇺🇸
Clearwater, Florida, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
Scripps Memorial Hospital - La Jolla
🇺🇸
La Jolla, California, United States
Tallahassee Research Institute
🇺🇸
Tallahassee, Florida, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
NC Heart & Vascular Research
🇺🇸
Raleigh, North Carolina, United States
Jackson Heart Clinic
🇺🇸
Jackson, Mississippi, United States
Anmed Health
🇺🇸
Anderson, South Carolina, United States
Pinnacle Health System
🇺🇸
Harrisburg, Pennsylvania, United States
Mission Research Institute
🇺🇸
New Braunfels, Texas, United States
East Texas Medical Center
🇺🇸
Tyler, Texas, United States
HeartPlace Methodist Richardson
🇺🇸
Richardson, Texas, United States
UNIVERSITATSMEDIZIN der Johannes Gutenberg-Universität MainzLangenbeckstrasse
🇩🇪
Mainz, Rhinela, Germany
Universitätsmedizin Berlin - Campus Benjamin Franklin (CBF)
🇩🇪
Berlin, Germany
Royal Bournemouth Hospital
🇬🇧
Bournemouth, Sowest, United Kingdom
Santa Barbara Cottage Hospital
🇺🇸
Santa Barbara, California, United States
McLaren Health Care Corporation
🇺🇸
Auburn Hills, Michigan, United States
Missouri Heart Center
🇺🇸
Columbia, Missouri, United States
Novant Health Heart and Vascular Research Institute
🇺🇸
Charlotte, North Carolina, United States
St. Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Sanford USD Medical Center
🇺🇸
Sioux Falls, South Dakota, United States
Austin Heart
🇺🇸
Austin, Texas, United States
Baylor Scott and White Heart and Vascular Hospital
🇺🇸
Dallas, Texas, United States
Mary Washington Hospital
🇺🇸
Fredericksburg, Virginia, United States
Onze-Lieve-Vrouwziekenhuis Campus Aalst
🇧🇪
Aalst, Eflndrs, Belgium
Jesse Ziekenhuis Campus Virga Jesse
🇧🇪
Limbourg, Belgium
Universitäts-Herzzentrum Freiburg - Bad Krozingen
🇩🇪
Bad Krozingen, Bad-Wur, Germany
Clinica Mediterranea
🇮🇹
Napoli, Campani, Italy
Azienda Ospedaliero Universitaria Policlinico Umberto I
🇮🇹
Rome, Latium, Italy
AOU di Parma
🇮🇹
Parma, Emi-rom, Italy
Hospital de Santa Cruz
🇵🇹
Carnaxide, Lisbon, Portugal
Hospital del Mar Passeig Maritim de la Barceloneta
🇪🇸
Barcelona, Catalon, Spain
Hospital Universitario Marqués de Valdecilla
🇪🇸
Santander, Cantabr, Spain
Southampton University Hospital
🇬🇧
Southampton, Soeast, United Kingdom
Royal Devon & Exeter Hospital
🇬🇧
Exeter, Sowest, United Kingdom
Wake Forest University Medical Center Clinical Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Northeast Georgia Medical Center
🇺🇸
Gainesville, Georgia, United States
The University of Hong Kong (Queen Mary Hospital)
🇭🇰
Hong Kong, Hong Kong
Prince of Wales Hospital
🇭🇰
Hong Kong, Hong Kong