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Nurmohamed NS, van Rosendael AR, Danad I, Ngo-Metzger Q, Taub PR, Ray KK, Figtree G, Bonaca MP, Hsia J, Rodriguez F, Sandhu AT, Nieman K, Earls JP, Hoffmann U, Bax JJ, Min JK, Maron DJ, Bhatt DL. Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography. Eur Heart J 2024; 45:1783-1800. [PMID: 38606889 PMCID: PMC11129796 DOI: 10.1093/eurheartj/ehae190] [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: 10/07/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit
Amsterdam, Amsterdam, The
Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of
Amsterdam, Amsterdam, The
Netherlands
- Division of Cardiology, The George Washington University School of
Medicine, Washington, DC, United States
| | | | - Ibrahim Danad
- Department of Cardiology, University Medical Center Utrecht,
Utrecht, The Netherlands
- Department of Cardiology, Radboud University Medical Center,
Nijmegen, The Netherlands
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson
School of Medicine, Pasadena, CA, United States
| | - Pam R Taub
- Section of Cardiology, Department of Medicine, University of
California, San Diego, CA, United States
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College
London, London, United
Kingdom
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney,
Australia, St Leonards, Australia
| | - Marc P Bonaca
- Department of Medicine, University of Colorado School of
Medicine, Aurora, CO, United States
| | - Judith Hsia
- Department of Medicine, University of Colorado School of
Medicine, Aurora, CO, United States
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - Alexander T Sandhu
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - Koen Nieman
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - James P Earls
- Cleerly, Inc., Denver, CO, United States
- Department of Radiology, The George Washington University School of
Medicine, Washington, DC, United States
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center,
Leiden, The Netherlands
| | | | - David J Maron
- Department of Medicine, Stanford University School of
Medicine, Stanford, CA, United States
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount
Sinai, 1 Gustave Levy Place, Box 1030, New York, NY
10029, United States
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Bawamia B, Brown A, Spyridopoulos I, Bagnall A, Edwards R, Purcell I, Egred M, Zaman A, Alkhalil M. Very Early Discharge After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Mortality Outcomes at Six Months. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:12-18. [PMID: 36058828 DOI: 10.1016/j.carrev.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Current guidelines recommend that low risk patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing uncomplicated primary percutaneous coronary intervention (PPCI) can be discharged home in 48-72 h. We report the safety of early discharge in STEMI patients undergoing uncomplicated PPCI after 24-h stay in-hospital. METHODS We performed a retrospective analysis of prospectively collected data of consecutive patients presenting with STEMI between January 2014 and December 2020. One- and 6-month mortality rates were compared between patients who underwent next day (early discharge group) and two days in-hospital stay (standard discharge group). RESULTS Of 6119 STEMI patients, 4033 were included in the analysis, of whom 1674 (42 %) underwent early discharge. Patients in the early discharge group were younger, more likely to be male, and had a lower peak troponin. Both groups had similar ischemia- and door-to-balloon time, but anterior STEMI were less frequent in the early discharge group. The 1- and 6-month mortality rate for the whole cohort was 0.6 % and 1.3 %, respectively. After adjustment, there were no significant differences in the 1-month [HR 0.54; 95 % CI (0.20 to 1.47), P = 0.23] and 6-month mortality [HR 0.73; 95 % CI (0.38 to 1.41), P = 0.35] between early and standard discharge groups. Age, admission heart rate and chronic obstructive lung disease were identified as independent predictors of 6-month mortality in patients who underwent early discharge strategy. CONCLUSION Our data confirms safety of next day discharge of patients presenting with STEMI after successful PPCI and uncomplicated post-procedural course.
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Affiliation(s)
- Bilal Bawamia
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Andrew Brown
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Ioakim Spyridopoulos
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Alan Bagnall
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Richard Edwards
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Ian Purcell
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Mohaned Egred
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
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Alkhalil M. An Overview of Current Advances in Contemporary Percutaneous Coronary Intervention. Curr Cardiol Rev 2022; 18:e150322202194. [PMID: 35297342 PMCID: PMC9241112 DOI: 10.2174/1573403x1801220315090538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mohammad Alkhalil
- Cardiothoracic Centre Freeman Hospital, Newcastle UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
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4
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Kuzemczak M, Ibrahem A, Alkhalil M. Colchicine in Patients with Coronary Artery Disease with or Without Diabetes Mellitus: A Meta-analysis of Randomized Clinical Trials. Clin Drug Investig 2021; 41:667-674. [PMID: 34176041 DOI: 10.1007/s40261-021-01056-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Whether the anti-inflammatory drug colchicine has a differential treatment effect according to diabetes mellitus status in patients with coronary artery disease has never been studied. Therefore, the aim of the present meta-analysis was to evaluate whether the use of colchicine in patients with coronary artery disease with diabetes was associated with a higher magnitude of benefits compared to patients with coronary artery disease without diabetes. METHODS Electronic databases were searched through June 2020 to identify randomized clinical trials using colchicine in patients with coronary artery disease. Studies using blood biomarkers, such as troponin or high-sensitive C-reactive protein, as well as angiographic endpoints were excluded. The primary endpoint was major cardiovascular events as defined by the included studies. RESULTS In total, 11,594 patients from four randomized trials were included of whom 2278 (19.6%) had diabetes and 5540 (47.8%) presented with acute coronary syndrome. Colchicine was associated with almost twice the absolute risk reduction in patients with diabetes {absolute risk difference (ARD) - 3.94 [95% confidence interval (CI) - 1.28 to - 6.6], p = 0.004} compared with those without diabetes [ARD - 2.32 (95% CI - 1.32 to - 3.31), p < 0.001]. The magnitude of ARD between colchicine and placebo was significantly larger in patients with diabetes compared with patients without diabetes [ARD 1.62 (95% CI 1.43-1.81), p < 0.001]. When the analysis was restricted to patients presenting with acute coronary syndrome, the differential treatment effect of colchicine was more pronounced in patients with diabetes [ARD - 0.05 (95% CI - 0.08 to - 0.01), p = 0.02] compared with those without diabetes [ARD - 0.01 (95% CI - 0.02 to 0), p = 0.11]. CONCLUSIONS This meta-analysis underscores the heightened inflammatory risk associated with diabetes and highlights the need to target inflammatory pathways in these individuals irrespective of glucose-lowering drugs.
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Affiliation(s)
- Michał Kuzemczak
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.,Division of Emergency Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Abdalazeem Ibrahem
- Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, NE7 7DN, UK
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, NE7 7DN, UK. .,Vascular Biology, Newcastle University, Newcastle-upon-Tyne, UK.
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