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Adejare A, Oloyo A, Dahud Y, Adeshina M, Agbaje A, Ejim C, Ismail-Badmus K, Jaja S. Renal denervation ameliorated salt-induced hypertension by improving cardiac work, cardiac enzyme and oxidative balance in Sprague-Dawley rats. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200290. [PMID: 38828466 PMCID: PMC11139768 DOI: 10.1016/j.ijcrp.2024.200290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/02/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
Background Hypertension is associated with cardiovascular dysfunction, dysregulation of the antioxidant system and alteration of the level of some enzymes in the metabolic pathway. The possible modulatory effect of acute renal denervation (ARD) on cardiovascular function and the antioxidant system is still a subject of intense debate. This study sought to ascertain the ameliorative effects of ARD on cardiovascular parameters, antioxidant system, creatine kinase and lactate dehydrogenase levels. Methods Thirty-six Sprague-Dawley rats (5-6 weeks old) were divided into 6 groups of 6 animals each consisting of Normal Salt, High Salt, Normal Salt + Sham Denervation, High Salt + Sham Denervation, Normal Salt + Renal Denervation and High Salt + Renal Denervation. Induction of hypertension with 8 % salt in the diet lasted for 8 weeks. Renal or Sham denervation was thereafter done on selected groups. At the end of the experimental period, cardiovascular parameters, plasma antioxidant status, plasma creatine kinase (CK) and lactate dehydrogenase (LDH) levels were assessed. Significance level was set at p < 0.05. Results Salt-loading significantly increased systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MABP), rate pressure product (RPP) while reducing superoxide dismutase (SOD), reduced glutathione (GSH) and catalase (CAT). Acute renal denervation significantly (p < 0.0001) reduced SBP, DBP, MABP, RPP, LDH and norepinephrine level while increasing SOD, GSH and CAT. ARD did not significantly alter CK level. Conclusion Acute renal denervation, by reducing sympathetic activity, ameliorates cardiovascular and antioxidant functions as well as reduces LDH level without significantly altering CK level in salt-induced hypertension.
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Affiliation(s)
- Abdullahi Adejare
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Ahmed Oloyo
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Yusuf Dahud
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Morufat Adeshina
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Abiola Agbaje
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Clinton Ejim
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Khadijah Ismail-Badmus
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Smith Jaja
- Cardiovascular-Renal Unit, Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine of the University of Lagos, Lagos, Nigeria
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2
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Damluji AA, Nanna MG, Rymer J, Kochar A, Lowenstern A, Baron SJ, Narins CR, Alkhouli M. Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series. JACC Cardiovasc Interv 2024; 17:961-978. [PMID: 38597844 PMCID: PMC11097960 DOI: 10.1016/j.jcin.2024.01.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/11/2024]
Abstract
Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Fairfax, Virginia, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Nanna
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Rymer
- Duke University School of Medicine, Durham, North Carolina USA
| | - Ajar Kochar
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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3
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Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach. Drugs Aging 2019; 36:531-539. [DOI: 10.1007/s40266-019-00663-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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4
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Vilaro JR. Stable Ischemic Heart Disease in the Older Adult. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Abstract
Due to the steady increase in life expectancy, the number of patients over 80 years of age proposed for coronary angioplasty is increasing significantly. The elderly patient is a patient at high cardiovascular risk and high risk of bleeding; whose severity of prognosis depends of comorbidities. The radial approach presents particularities and technical difficulties that have to be known in this part of the population, but reduce vascular and hemorrhagic complications, as well as mortality. Because of greater safety, the radial approach is therefore the first choice for the elderly.
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Affiliation(s)
- A Rougé
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - M Abdellaoui
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - B Faurie
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
| | - J Monségu
- Institut cardiovasculaire, groupe hospitalier mutualiste, 8, rue Dr Calmette, 38000 Grenoble, France.
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6
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Transradial approach for coronary angiography and intervention in the elderly: A meta-analysis of 777,841 patients. Int J Cardiol 2017; 228:45-51. [DOI: 10.1016/j.ijcard.2016.11.207] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/06/2016] [Indexed: 01/11/2023]
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7
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Wu T, Sun R, Huang Y, Wang Z, He J, Shen S, Yin X, Zhu Z, Yang W, Zhao Z. Partial splenic embolization of patients with hypersplenism by transradial or transfemoral approach: a prospective randomized controlled trial. Acta Radiol 2016; 57:1201-4. [PMID: 26671306 DOI: 10.1177/0284185115622076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 11/13/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Partial splenic artery embolization (PSE) is an effective treatment modality for patients with hypersplenism. It is less invasive and has a quicker recovery compared with surgical procedures. PSE is usually performed using a femoral artery approach that requires bedrest for a few hours, which is rarely the case for transradial PSE. PURPOSE To compare the transradial and transfemoral approaches for embolization of spleen in patients with hypersplenism. MATERIAL AND METHODS In all, 84 patients with hypersplenism who required PSE were recruited. They were randomly divided into two groups on the basis of the procedure followed: the transradial approach (R-PSE, n = 39) or transfemoral approach (F-PSE, n = 45). Technical success, puncture rate, total procedure time, X-ray exposure time, length of stay in hospital (LOS), and complications of the two groups were recorded. RESULTS The procedure time, X-ray exposure time, and LOS were found to be lower in the R-PSE group than in the F-PSE. However, this difference was not statistically significant. CONCLUSION The transradial artery approach for PSE in patients with hypersplenism is feasible with no major complications as compared to the femoral approach.
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Affiliation(s)
- Tao Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Ruimin Sun
- Department of Operation Room, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Yinuo Huang
- Department of Gastroenterology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Zhixue Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Jue He
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Songhe Shen
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Xiaoxiang Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Zhixiang Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Wenyi Yang
- Department of Gastroenterology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
| | - Zhijun Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Henan University, Kaifeng, Henan, PR China
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8
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Tammam K, Ikari Y, Yoshimachi F, Saito F, Hassan W. Impact of transradial coronary intervention on bleeding complications in octogenarians. Cardiovasc Interv Ther 2016; 32:18-23. [PMID: 26910467 DOI: 10.1007/s12928-016-0383-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Percutaneous coronary intervention (PCI) in the elderly is a major hospital burden since this group of patients exhibits high mortality rates and many comorbidities. The aim of this study was to analyze the impact of a transradial intervention (TRI) approach for PCI on bleeding complications in octogenarians. We retrospectively analyzed a consecutive cohort of 2530 patients who underwent PCI at a tertiary care center in Japan. Octogenarians constituted 12 % (291 cases) of the total PCI cases during the study period. Bleeding complications and all-cause mortality were observed at 30 days after PCI. Average age was 83 ± 3 years and female gender was 32 %. Stable coronary artery disease was 59 %. TRI was performed in 218 patients (75 %) and transfemoral intervention (TFI) in 73 (25 %). Bleeding Academic Research Consortium (BARC) major bleeding unrelated to bypass surgery were observed in 7.6 %, which were significantly lower in TRI than TFI (5.1 vs. 15.1 %, P = 0.005). The 30-day mortality rate was significantly low in patients without bleeding (4.9 vs. 31 %, p < 0.0001). In octogenarians, major bleeding complication was significant at 30 days after PCI. TRI had lower bleeding complication rate than TFI in this population. Octogenarians may be a subgroup of patients who derive benefits from TRI.
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Affiliation(s)
- Khalid Tammam
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, 259-1193, Japan.
| | - Fuminobu Yoshimachi
- Department of Cardiology, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Fumie Saito
- Department of Cardiology, Tokai University School of Medicine, Isehara, 259-1193, Japan
| | - Walid Hassan
- Cardiac Center of Excellence, International Medical Center, Jeddah, Saudi Arabia
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9
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Toleva O, Ibrahim Q, Brass N, Sookram S, Welsh R. Treatment choices in elderly patients with ST: elevation myocardial infarction-insights from the Vital Heart Response registry. Open Heart 2015; 2:e000235. [PMID: 26196017 PMCID: PMC4488892 DOI: 10.1136/openhrt-2014-000235] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 05/12/2015] [Accepted: 06/03/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Management of elderly patients with ST elevation myocardial infarction (STEMI) is challenging and they are under-represented in trials. Accordingly, we analysed reperfusion strategies and their effectiveness in patients with STEMI ≥75 years compared to <75 years within a comprehensive inclusive registry. METHODS Consecutive patients with STEMI admitted to hospital and tracked within a regional registry (2006-2011) were analysed comparing reperfusion strategy (primary percutaneous coronary intervention (PPCI), fibrinolysis and no reperfusion) between patients ≥75 vs <75 years old as well as across the reperfusion strategies in those ≥75 years. RESULTS There were 3588 patients with STEMI with 646 (18%) ≥75 years old. Elderly patients were more likely female (46.9% vs 18.4%) and had more prior: angina (28.2% vs 17.2%), myocardial infarction (MI; 22.8% vs 13.9%), hypertension (67.6% vs 44.2%), heart failure (2.3% vs 0.3%) and atrial fibrillation (2.2% vs 0.5%) (all p<0.001). The reperfusion strategy for patients ≥75 vs <75: PPCI 45.3% vs 41.2%, fibrinolysis 24.8% vs 45.7%, and no reperfusion 29.9% vs 13.1% (p<0.001). Time from symptoms to first medical contact (median, 93 vs 78 min p=0.008) and PPCI (median, 166 vs 136 min (p<0.001) were longer for ≥75 years. In those ≥75 years outcomes by reperfusion (PPCI, fibrinolysis and none) were: in-hospital death 13.3%, 9.4% and 19.7% (p=0.018), and composite of death, recurrent-MI, cardiogenic shock and congestive heart failure 28%, 20% and 33.2% (p=0.022). CONCLUSIONS Elderly patients have more comorbidities, worst in-hospital clinical outcomes and are less likely to receive reperfusion. Acknowledging physician selection of the reperfusion strategy; outcomes appear favourable in the elderly receiving fibrinolysis.
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Affiliation(s)
- Olga Toleva
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Neil Brass
- Royal Alexandra Hospital and CK Hui Heart Centre, Edmonton, Alberta, Canada
| | | | - Robert Welsh
- University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Alberta Heart Institute,Edmonton, Alberta, Canada
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Howe MJ, Seth M, Riba A, Hanzel G, Zainea M, Gurm HS. Underutilization of Radial Access in Patients Undergoing Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002036. [DOI: 10.1161/circinterventions.114.002036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background—
The purpose of this study was to evaluate the frequency and temporal trends in use of transradial access (TRA) for percutaneous coronary intervention (PCI) in ST-segment–elevation myocardial infarction (STEMI). The use of TRA has been associated with less bleeding and improved clinical outcomes in patients undergoing PCI for STEMI.
Methods and Results—
The frequency of TRA compared with transfemoral access for patients undergoing PCI for STEMI or other indications (non–ST-segment–elevation myocardial infarction, unstable angina, and non–acute coronary syndrome) in The Blue Cross Blue Shield of Michigan Cardiovascular Consortium database between 2010 and 2013 was evaluated. Propensity matching was used to assess the relationship of TRA with in-hospital clinical end points of major bleeding, transfusion, and death. The TRA cohort of patients was stratified into deciles based on their predicted bleeding risk and compared with PCI indication. Of 122 728 PCI procedures, 17 912 (14.6%) were via TRA. Among patients with STEMI cases, 8.3% of the PCI cases were performed via TRA. The use of TRA increased over the study period although the growth was slower for STEMI than for other indications,
P
<0.001. The use of TRA for PCI in STEMI was associated with a lower rate of bleeding (11.7% versus 20.0%;
P
<0.001) and vascular complications (0.7% versus 2.6%;
P
=0.001), but no mortality difference (1.25% versus 2.33%;
P
=0.175). There was a strong negative association between the predicted risk of bleeding and the use of TRA (
P
<0.001).
Conclusions—
The use of radial access for PCI in STEMI is increasing but at a slower pace than for patients with other indications. TRA was associated with a reduction in bleeding and transfusion, but there is a strong negative correlation between the predicted risk of bleeding and actual use of TRA in STEMI.
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Affiliation(s)
- Michael J. Howe
- From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.)
| | - Milan Seth
- From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.)
| | - Arthur Riba
- From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.)
| | - George Hanzel
- From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.)
| | - Mark Zainea
- From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.)
| | - Hitinder S. Gurm
- From the Division of Cardiovascular Medicine, Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor (M.J.H., M.S., H.S.G.); Division of Cardiovascular Medicine, Department of Medicine, Oakwood Healthcare System, Dearborn, MI (A.R.); Division of Cardiovascular Medicine, Department of Medicine, Beaumont Hospital, Royal Oak, MI (G.H.); and Division of Cardiovascular Medicine, Department of Medicine, McLaren Macomb, McLaren Healthcare, Mt. Clemens, MI (M.Z.)
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Mustafa AHS, Holroyd E, Butler R, Fraser D, El-Omar M, Nolan J, Mamas MA. Transradial Intervention in ST Elevation Myocardial Infarction. Curr Cardiol Rep 2015; 17:30. [DOI: 10.1007/s11886-015-0585-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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12
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Mirza O, Challa K, Yallapragada S, Banankhah P, Shroff A. Transradial approaches in women and the elderly: deciphering the challenges and opportunities. Interv Cardiol 2014. [DOI: 10.2217/ica.14.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Prognosis of elderly ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Am Heart J 2014; 168:e3. [PMID: 24952871 DOI: 10.1016/j.ahj.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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