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Gallagher SM, Lovell MJ, Jones DA, Ferguson E, Ahktar A, Buckhoree Z, Wragg A, Knight CJ, Mathur A, Smith EJ, Cliffe S, Archbold RA, Rothman MT, Jain AK. Does a 'direct' transfer protocol reduce time to coronary angiography for patients with non-ST-elevation acute coronary syndromes? A prospective observational study. BMJ Open 2014; 4:e005525. [PMID: 25270854 PMCID: PMC4179416 DOI: 10.1136/bmjopen-2014-005525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE National guidelines recommend 'early' coronary angiography within 96 h of presentation for patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Most patients with NSTE-ACS present to their district general hospital (DGH), and await transfer to the regional cardiac centre for angiography. This care model has inherent time delays, and delivery of timely angiography is problematic. The objective of this study was to assess a novel clinical care pathway for the management of NSTE-ACS, known locally as the Heart Attack Centre-Extension or HAC-X, designed to rapidly identify patients with NSTE-ACS while in DGH emergency departments (ED) and facilitate transfer to the regional interventional centre for 'early' coronary angiography. METHODS This was an observational study of 702 patients divided into two groups; 391 patients treated before the instigation of the HAC-X pathway (Pre-HAC-X), and 311 patients treated via the novel pathway (Post-HAC-X). Our primary study end point was time from ED admission to coronary angiography. We also assessed the length of hospital stay. RESULTS Median time from ED admission to coronary angiography was 7.2 (IQR 5.1-10.2) days pre-HAC-X compared to 1.0 (IQR 0.7-2.0) day post-HAC-X (p<0.001). Median length of hospital stay was 3.0 (IQR 2.0-6.0) days post-HAC-X v 9.0 (IQR 6.0-14.0) days pre-HAC-X (p<0.0005). This equates to a reduction of six hospital bed days per NSTE-ACS admission. CONCLUSIONS The introduction of this novel care pathway was associated with significant reductions in time to angiography and in total hospital bed occupancy for patients with NSTE-ACS.
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Born T, Huynh Q, Mathur A, Velayudhan J, Canon J, Reynhardt K, Goletz T, Markus R. Functional Similarity Assessment Results Comparing Bevacizumab to Biosimilar Candidate Abp 215. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cailhol L, Riedi G, Mathur A, Czapla P, Charpentier S, Genestal M, Birmes P. [Should hospitalization be required after the emergency discharge of patients with borderline personality disorder who have attempted suicide (FRENCH CRISIS cohort)?]. Encephale 2014; 40:289-94. [PMID: 24815791 DOI: 10.1016/j.encep.2013.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. There is a high prevalence of BPD patients among those admitted to the emergency department for suicide attempts. However, little empirical research exists to assist clinicians in deciding whether to hospitalize a suicidal patient. Some authors have argued that hospitalization does not prevent suicide and could actually harm these patients, thereby leading to psychosocial regression. Parasuicidal behaviors could be reinforced by the attention given during hospitalization. OBJECTIVE Our purpose was to determine whether the hospitalization of suicidal patients who have a high risk of BPD after discharge from the emergency department is associated with a recurrence of suicidal behavior at 6months. METHOD We designed a prospective study, acquiring patients from three emergency hospitals. The participants were suicidal subjects admitted for voluntary drug intoxication and were 18years of age or older. The participants completed the Personality Disorder Questionnaire (PDQ-4+) to assess BPD symptomatology. Information on the recurrence of suicidal behavior at 6months was obtained by interview of patients and the review of the charts from the 3 hospitals involved in the study. Other assessments included the BDI-13 (severity of depression), the Hopelessness Scale (hopelessness), the TAS-20 (alexythymia), the AUDIT (alcohol disorder) and the MINI (axis I disorders). RESULTS A total of 606 subjects admitted for a suicide attempt participated in this study. A total of 320 (52.8 %) of the subjects completed the PDQ-4+. The sample was divided into three groups: participants at high risk of having at least one BPD (n=197), a group at high risk of having at least one non-BPD PD (n=84) and a group with low risk of having a PD (n=39). Hospitalization following an emergency was not associated with a recurrence of suicide attempts at 6months among patients at high risk of BPD. A logistical regression analysis showed pre-hospitalization antidepressant prescription to be associated with recidivism (OR=2.1, P=.037). CONCLUSION Our exploratory study suggests that hospitalization may not increase suicide attempts among patients with BPD when the health organization does not include a specific device such as DBT.
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Awad W, Mathur A, Baldock L, Oliver S, Kennon S. Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK. J Med Econ 2014; 17:357-64. [PMID: 24621135 DOI: 10.3111/13696998.2014.904322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To define the in-hospital and 6-month post-discharge resource use, following Transcatheter Aortic Valve Implantation (TAVI) and conventional Aortic Valve Replacement (AVR) surgery within a single UK hospital. METHODS A local service evaluation of patients undergoing TAVI or AVR between January 2011 and May 2012 captured data until 6-months post-procedure, collected from hospital records and via a General Practitioner questionnaire. The main end-points were mortality, time in ITU/HDU, hospital length of stay (LoS), discharge destination, re-admission, and post-discharge primary/secondary care resource use. Sub-group analyses were performed for AVR patients aged ≥80 (AVR ≥ 80) and with EuroSCORE of ≥10 (AVR ES ≥ 10) to allow more direct comparison with 'TAVI type' patients. RESULTS Results are given as means (standard deviation) for TAVI (n = 51), AVR (n = 188), AVR ≥ 80 (n = 48), and AVR ES ≥ 10 (n = 47), respectively, unless otherwise stated. Age in years was 83.0 (8.1), 71.2 (13.1), 84.1 (2.7), 79.4 (7.1); EuroSCORE was 24.7 (11.9), 8.1 (6.4), 12.0 (6.0), and 16.5 (6.6); post-operative LoS (days) was 11.5 (11.2), 10.9 (10.8), 14.3 (16.7), and 15.2 (17.7). For discharged patients, 0%, 7%, 13%, and 9% had unplanned cardiac-related re-admissions within 30-days of discharge. Time to first readmission was 74.6 (34.0), 35.0 (34.2), 20.8 (9.7), and 22.6 (14.3) days. LIMITATIONS This was a single-center retrospective evaluation, not prospectively powered to confirm differences in outcomes. CONCLUSIONS Despite TAVI being performed in an older, higher risk population, LoS was similar to AVR. Most strikingly there were no cardiac-related re-admissions within 30-days for TAVI and time to first re-admission was significantly longer. This evaluation suggests that TAVI is clinically appropriate and provides economic advantages in both the hospital and post-discharge setting in this high risk group. Many patients undergoing TAVI are considered unfit for surgery and, hence, TAVI offers a treatment that delivers similar results to traditional AVR without the high risk associated with surgery.
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Mathur A, Kasetty R, Oxley J, Mendez J, Nithyanandam K. Using Encapsulated Phase Change Salts for Concentrated Solar Power Plant. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.egypro.2014.03.098] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abdullah A, Omar AN, Mulcahy R, Clapp A, Tullo E, Carrick-Sen D, Newton J, Hirst B, Krishnaswami V, Foster A, Vahidassr D, Chavan T, Matthew A, Trolan CP, Steel C, Ellis G, Ahearn DJ, Lotha K, Shukla P, Bourne DR, Mathur A, Musarrat K, Patel A, Nicholson G, Nelson E, McNicholl S, McKee H, Cuthbertson J, Nelson E, Nicholson G, McNicholl S, McKee H, Cuthbertson J, Lunt E, Lee S, Okeke J, Daniel J, Naseem A, Ramakrishna S, Singh I, Barker JR, Weatherburn AJ, Thornton L, Daniel J, Okeke J, Holly C, Jones J, Varanasi A, Verma A, Singh I, Foster JAH, Carmichael C, Cawston C, Homewood S, Leitch M, Martin J, McDicken J, Lonnen J, Bishop-Miller J, Beishon LC, Harrison JK, Conroy SP, Gladman JRF, Sim J, Byrne F, Currie J, Ollman S, Brown S, Wilkinson M, Manoj A, Hussain F, Druhan A, Thompson M, Tsang J, Soh J, Offiah C, Coughlan T, O'Brien P, McCabe DJH, Murphy S, McManus J, O'Neill D, Collins DR, Warburton K, Maini N, Cunnington AL, Mathew P, Hoyles K, Lythgoe M, Brewer H, Western-Price J, Colquhoun K, Ramdoo K, Bowen J, Dale OT, Corbridge R, Chatterjee A, Gosney MA, Richardson L, Daunt L, Ali A, Harwood R, Beveridge LA, Harper J, Williamson LD, Bowen JST, Gosney MA, Wentworth L, Wardle K, Ruddlesdin J, Baht S, Roberts N, Corrado O, Morell J, Baker P, Whiller N, Wilkinson I, Barber M, Maclean A, Frieslick J, Reoch A, Thompson M, Tsang J, McSorley A, Crawford A, Sarup S, Niruban A, Edwards JD, Bailey SJ, May HM, Mathieson P, Jones H, Ray R, Prettyman R, Gibson R, Heaney A, Hull K, Manku B, Bellary S, Ninan S, Chhokar G, Sweeney D, Nivatongs W, Wong SY, Aung T, Kalsi T, Babic-Illman G, Harari D, Aljaizani M, Pattison AT, Pattison AT, Aljaizani M, Fox J, Reilly S, Chauhan V, Azad M, Youde J, Lagan J, Cooper H, Komrower D, Price V, von Stempel CB, Gilbert B, Bouwmeester N, Jones HW, Win T, Weekes C, Hodgkinson R, Walker S, Le Ball K, Muir ZN. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rossi A, Dharampal A, Wragg A, Davies LC, van Geuns RJ, Anagnostopoulos C, Klotz E, Kitslaar P, Broersen A, Mathur A, Nieman K, Hunink MGM, de Feyter PJ, Petersen SE, Pugliese F. Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it predict functionally significant coronary lesions? Eur Heart J Cardiovasc Imaging 2013; 15:85-94. [DOI: 10.1093/ehjci/jet133] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stephenson E, Monney P, Boubertakh R, Nackvi J, Sekhri N, Mills P, Wragg A, Mathur A, Petersen S, Mohiddin SA. Apical hypertrophic cardiomyopathy: chest pain and myocardial perfusion defects result from regional diastolic persistence of hyperdynamic cardiac contractility. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rathod KS, Jones DA, Gallagher SM, Bromage DI, Rathod VS, Mathur A, Jain AK, Wragg A, Knight C. Out of hours primary PCI is not associated with increased adverse outcomes compared to in-hour procedures. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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85
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Akhtar MM, Jones DA, Ding N, Gallagher S, Rathod KS, Jain A, Knight C, Mathur A, Weerackody R, Wragg A. Eptifibatide and abciximab are associated with similar outcomes when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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86
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Koganti S, Fung K, Jones D, Rathod K, Gallagher S, Weerackody R, Amersey R, Mathur A, Knight C, Wragg A. No difference in mortality between immediate vs delayed staged intervention of non culprit vessel in patients with multivessel disease following primary angioplasty. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Herman TE, Siegel MJ, Mathur A, Vachharajani A. Neonatal marfan syndrome with hiatus hernia and intrathoracic stomach. J Perinatol 2013; 33:652-3. [PMID: 23897310 DOI: 10.1038/jp.2013.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 11/09/2022]
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Howard JP, Jones D, Rathod KS, Bromage DI, Ding N, Gallagher S, Jain AK, Knight CJ, Mathur A, Wragg A. 040 THE EFFECT OF GLYCOPROTEIN IIBIIIA INHIBITORS ON MORTALITY FOLLOWING PCI FOR NSTEMI/UA. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Choudry FA, Weerackody RP, Wragg A, Mathur A, Mills PG, Jain AK. 029 PREDICTORS OF SURVIVAL AND NEUROLOGICAL RECOVERY IN ST-ELEVATION MYOCARDIAL INFARCTION COMPLICATED BY OUT OF HOSPITAL CARDIAC ARREST. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Modi BN, Jones DA, Rathod KS, Akhtar M, Jain AK, Singh Kalra S, Crake T, Meier P, Astroulakis Z, Dollery C, Ozkur M, Rakhit R, Knight CJ, Dalby MC, Malik IS, Bunce N, Lim P, Virdi G, Whitbread M, Weerackody R, Mathur A, Redwood S, MacCarthy PA, Wragg A. 046 MECHANICAL THROMBECTOMY USE IS ASSOCIATED WITH DECREASED MORTALITY IN PATIENTS TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION (9935 PATIENTS FROM THE LONDON HEART ATTACK GROUP). BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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91
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Rawal B, Jones DA, Rathod KS, Gallagher S, Jain A, Westwood M, Knights CJ, Mathur A, Weerackody R, Wragg A. 094 CLINICAL USE OF CARDIAC STRESS PERFUSION MRI SCAN TO GUIDE TREATMENT OF NON CULPRIT CORONARY ARTERY DISEASE IN PATIENTS WITH MULTI-VESSEL DISEASE UNDERGOING PPCI FOR STEMI. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fung K, Koganti S, Jones DA, Rathod KS, Gallagher S, Jain A, Knight CJ, Mathur A, Amersey R, Weerackody R, Wragg A. 063 TIMING OF STAGED INTERVENTION FOR NON-CULPRIT DISEASE IN PATIENTS WITH MULTI-VESSEL DISEASE UNDERGOING PPCI FOR STEMI. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bromage DI, AJones D, Rathod KS, Lim P, Virdi G, Jain AJ, Singh Kalra S, Crake T, Meier P, Astroulakis Z, Dollery C, Ozkor M, Rakhit R, Knight CJ, Dalby MC, Malik IS, Bunce N, Whitbread M, Grout C, Mathur A, Redwood S, MacCarthy PA, Wragg A. 037 OUTCOME OF 1051 OCTOGENARIANS AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION: OBSERVATIONAL COHORT FROM THE LONDON HEART ATTACK GROUP. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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94
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Lim VG, Jones DA, Gallagher S, Rathod KS, Jain A, Knight C, Mathur A, Wragg A. 064 LONG-TERM OUTCOME AMONG PATIENTS WITH EARLY, LATE, AND VERY LATE STENT THROMBOSIS FOLLOWING PREVIOUS PCI FOR ST-ELEVATION MYOCARDIAL INFARCTION. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Akhtar MM, Jones DA, Rathod KS, Modi B, Lim P, Virdi G, Bromage D, Jain AJ, Singh Kalra S, Crake T, Meier P, Astroulakis Z, Dollery C, Ozkur M, Rakhit R, Knight CJ, Dalby MC, Malik IS, Bunce N, Whitbread M, Mathur A, Redwood S, MacCarthy PA, Wragg A. 041 CORONARY ARTERY BYPASS GRAFT PATIENTS TREATED WITH PRIMARY PERCUTANEOUS CORONARY INTERVENTION HAVE HIGH LONG-TERM ADVERSE EVENT RATES (10 920 STEMI PATIENTS FROM THE LONDON HEART ATTACK GROUP). BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jones DA, Bromage DI, Rathod KS, Lim P, Virdi G, Jain AJ, Singh Kalra S, Crake T, Meier P, Astroulakis Z, Dollery C, Ozkur M, Rakhit R, Knight CJ, Dalby MC, Maliq IS, Bunce N, Whitbread M, Mathur A, Redwood S, MacCarthy PA, Wragg A. 030 IMPACT OF INTER-HOSPITAL TRANSFER FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION ON SURVIVAL (10 108 STEMI PATIENTS FROM THE LONDON HEART ATTACK GROUP). BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rathod KS, Jones DA, Bromage DI, Gallagher SM, Mathur A, Jain AK, Wragg A, Knight C. 065 OUT OF HOURS PRIMARY PCI IS NOT ASSOCIATED WITH INCREASED ADVERSE OUTCOMES COMPARED TO IN-HOUR PROCEDURES. BRITISH HEART JOURNAL 2013. [DOI: 10.1136/heartjnl-2013-304019.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sattur S, Mathur A, Acharji S, Waller AH, Prasad H, Singh M, Rudzinski W, Kaluski E. Fractional flow reserve at 2013: an update. Minerva Cardioangiol 2013; 61:21-32. [PMID: 23381377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Fractional flow reserve (FFR) has become an extremely valuable tool for assessing the hemodynamic significance of intermediate coronary lesions in patients with stable coronary syndromes. This manuscript delineates the current data supporting FFR use to guide cardiovascular interventions in comparison to other invasive and non-invasive modalities. The correlation between FFR, symptom severity and likelihood of future major cardiovascular events are critically examined in view of the FAME-2 study results. The authors delineate the scientific gaps, potential pitfalls and misconceptions related to FFR with regards to current and emerging indications. Described are the most important developments related to FFR in 2012: instantaneous wave free ratio and non-invasive CT angiography based FFR. The manuscript proposes areas of future research to enhance the scientific data supporting current FFR clinical algorithms and strategies.
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K. S, Tiwari S, Saxena R, Mathur A, N. Nair MP. Japanese Encephalitis Virus: The Complex Biology of an Emerging Pathogen. ENCEPHALITIS 2013. [DOI: 10.5772/54111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Jones DA, Andiapen M, Van-Eijl TJA, Webb AJ, Antoniou S, Schilling RJ, Ahluwalia A, Mathur A. The safety and efficacy of intracoronary nitrite infusion during acute myocardial infarction (NITRITE-AMI): study protocol of a randomised controlled trial. BMJ Open 2013; 3:bmjopen-2013-002813. [PMID: 23550096 PMCID: PMC3641434 DOI: 10.1136/bmjopen-2013-002813] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a major cause of death and disability in the UK and worldwide. Presently, timely and effective reperfusion with primary percutaneous coronary intervention (PPCI) remains the most effective treatment strategy for limiting infarct size, preserving left ventricular ejection fraction (LVEF) and improving clinical outcomes. However, the process of reperfusion can itself induce cardiomyocyte death, known as myocardial reperfusion injury, for which there is currently no effective therapy. Extensive preclinical evidence exists to suggest that sodium nitrite (as a source of endogenous nitric oxide) is an effective therapeutic strategy for preventing myocardial reperfusion injury. The purpose of NITRITE-AMI is to test whether sodium nitrite reduces reperfusion injury and subsequent infarct size in patients undergoing PPCI for MI. METHODS AND DESIGN NITRITE-AMI is a double-blind, randomised, single-centre, placebo-controlled trial to determine whether intracoronary nitrite injection reduces infarct size in patients with myocardial infarction undergoing primary angioplasty. The study will enrol 80 patients presenting with ST-elevation myocardial infarction. Patients will be randomised to receive either a bolus of intracoronary sodium nitrite or placebo (sodium chloride) at the time of PPCI. The primary outcome is infarct size assessed by creatine kinase area under the curve (AUC) over 48 h. Secondary endpoints include troponin T AUC and infarct size, LV dimensions and myocardial salvage index assessed by cardiac MR (CMR), markers of platelet reactivity and inflammation, the safety and tolerability of intracoronary nitrite, and 1 year major adverse cardiac events. ETHICS AND DISSEMINATION The study is approved by the local ethics committee (NRES Committee London West London: 11/LO/1500) and by the Medicines and Healthcare Products Regulatory Agency (MHRA) (EudraCT nr. 2010-022460-12). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION United Kingdom Clinical Research Network (Study ID 12117), http://clinicaltrials.gov (NCT01584453) and Current Controlled Trials (ISRCTN:38736987).
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