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Bhogal S, Kallur A, Merdler I, Ben-Dor I, Devineni A, Hashim HD, Bernardo NL, Rogers T, Wermers JP, Satler LF, Garcia-Garcia HM, Waksman R. Aspiration Thrombectomy With and Without Cangrelor During Percutaneous Coronary Intervention. Am J Cardiol 2023; 209:89-91. [PMID: 37871514 DOI: 10.1016/j.amjcard.2023.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/05/2023] [Accepted: 08/12/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Akhil Kallur
- Section of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Aditya Devineni
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Hayder D Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Rajakariar K, Andrianopoulos N, Gayed D, Liang D, Backhouse B, Ajani AE, Duffy SJ, Brennan A, Roberts L, Reid CM, Oqueli E, Clark D, Freeman M. Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Intern Med J 2023; 53:1376-1382. [PMID: 35670161 DOI: 10.1111/imj.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). AIM To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI. METHODS We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality. RESULTS We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63-0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85-1.1; P = 0.73). CONCLUSION The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone.
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Affiliation(s)
- Kevin Rajakariar
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Gayed
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Danlu Liang
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Brendan Backhouse
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
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Resnic FS, Majithia A, Dhruva SS, Ssemaganda H, Robbins S, Marinac-Dabic D, Hewitt K, Ohno-Machado L, Reynolds MR, Matheny ME. Active Surveillance of the Implantable Cardioverter-Defibrillator Registry for Defibrillator Lead Failures. Circ Cardiovasc Qual Outcomes 2020; 13:e006105. [PMID: 32283971 DOI: 10.1161/circoutcomes.119.006105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several defibrillator leads have been recalled due to early lead failure leading to significant patient harm. Confirming the safety of contemporary defibrillator leads is essential to optimizing treatment for patients receiving implantable cardioverter-defibrillators (ICDs). We therefore sought to assess the comparative long-term safety of the 4 most commonly implanted ICD leads within the National Cardiovascular Data Registry ICD Registry. METHODS AND RESULTS A propensity-matched survival analysis of the ICD Registry was performed evaluating 4 contemporary ICD leads in patients receiving an ICD system for the first time. All patients in the ICD Registry aged ≥18 years who underwent an implant of an ICD between April 1, 2011 and March 31, 2016 were included. Monitoring of safety began with ICD implant and continued up to 5 years. A meaningful difference in ICD failure rate was defined as twice (or more) the lead failure rate observed in the propensity-matched comparator patients. Among the 374 132 patients who received a new ICD implant, no safety alerts were triggered for the primary safety end point of lead failure for any of the high energy leads studied. Estimated rates of freedom from lead failure at 5 years ranged from 97.7% to 98.9% for the 4 high-energy leads of interest. CONCLUSIONS Though limited by incomplete long-term outcomes ascertainment, active surveillance of the ICD Registry suggests that there were no meaningful differences in the rate of ICD high-energy lead survival for the 4 most commonly used high-energy ICD leads.
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Affiliation(s)
- Frederic S Resnic
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Arjun Majithia
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Brigham and Women's Hospital, Boston, MA (A.M.)
| | - Sanket S Dhruva
- UCSF School of Medicine and Section of Cardiology, San Francisco VA Health Care System (S.S.D.)
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Susan Robbins
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD (D.M.-D.)
| | - Kathleen Hewitt
- National Cardiovascular Data Registry, American College of Cardiology, Washington, DC (K.H.)
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla (L.O.-M.)
| | - Matthew R Reynolds
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville (M.E.M.).,Departments of Biomedical Informatics, Biostatistics and Medicine, Vanderbilt University Medical Center, Nashville, TN (M.E.M.)
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Affiliation(s)
- Emily P. Zeitler
- Dartmouth-Hitchcock Medical Center and The Dartmouth Institute, Lebanon, NH (E.P.Z.)
- Geisel School of Medicine at Dartmouth, Hanover, NH (E.P.Z.)
| | - Kimberly A. Selzman
- George E. Wahlen Department of Veterans Affairs Medical Center and University of Utah School of Medicine, Salt Lake City, UT (K.A.S.)
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Resnic F, Majithia A. Active surveillance for implanted devices: strength in numbers. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2019; 1:e000017. [PMID: 35047779 PMCID: PMC8647611 DOI: 10.1136/bmjsit-2019-000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Frederic Resnic
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Arjun Majithia
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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