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Kelham M, Beirne AM, Rathod KS, Andiapen M, Wynne L, Ramaseshan R, Learoyd AE, Forooghi N, Moon JC, Davies C, Bourantas CV, Baumbach A, Manisty C, Wragg A, Ahluwalia A, Pugliese F, Mathur A, Jones DA. The effect of CTCA guided selective invasive graft assessment on coronary angiographic parameters and outcomes: Insights from the BYPASS-CTCA trial. J Cardiovasc Comput Tomogr 2024; 18:291-296. [PMID: 38462389 DOI: 10.1016/j.jcct.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Computed tomography cardiac angiography (CTCA) is recommended for the evaluation of patients with prior coronary artery bypass graft (CABG) surgery. The BYPASS-CTCA study demonstrated that CTCA prior to invasive coronary angiography (ICA) in CABG patients leads to significant reductions in procedure time and contrast-induced nephropathy (CIN), alongside improved patient satisfaction. However, whether CTCA information was used to facilitate selective graft cannulation at ICA was not protocol mandated. In this post-hoc analysis we investigated the influence of CTCA facilitated selective graft assessment on angiographic parameters and study endpoints. METHODS BYPASS-CTCA was a randomized controlled trial in which patients with previous CABG referred for ICA were randomized to undergo CTCA prior to ICA, or ICA alone. In this post-hoc analysis we assessed the impact of selective ICA (grafts not invasively cannulated based on the CTCA result) following CTCA versus non-selective ICA (imaging all grafts irrespective of CTCA findings). The primary endpoints were ICA procedural duration, incidence of CIN, and patient satisfaction post-ICA. Secondary endpoints included the incidence of procedural complications and 1-year major adverse cardiac events. RESULTS In the CTCA cohort (n = 343), 214 (62.4%) patients had selective coronary angiography performed, whereas 129 (37.6%) patients had non-selective ICA. Procedure times were significantly reduced in the selective CTCA + ICA group compared to the non-selective CTCA + ICA group (-5.82min, 95% CI -7.99 to -3.65, p < 0.001) along with reduction of CIN (1.5% vs 5.8%, OR 0.26, 95% CI 0.10 to 0.98). No difference was seen in patient satisfaction with the ICA, however procedural complications (0.9% vs 4.7%, OR 0.21, 95% CI 0.09-0.87) and 1-year major adverse cardiac events (13.1% vs 20.9%, HR 0.55, 95% CI 0.32-0.96) were significantly lower in the selective group. CONCLUSIONS In patients with prior CABG, CTCA guided selective angiographic assessment of bypass grafts is associated with improved procedural parameters, lower complication rates and better 12-month outcomes. Taken in addition to the main findings of the BYPASS-CTCA trial, these results suggest a synergistic approach between CTCA and ICA should be considered in this patient group. REGISTRATION ClinicalTrials.gov, NCT03736018.
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Affiliation(s)
- Matthew Kelham
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Lucinda Wynne
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Rohini Ramaseshan
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Annastazia E Learoyd
- Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom
| | - Nasim Forooghi
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - James C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ceri Davies
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Christos V Bourantas
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Charlotte Manisty
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andrew Wragg
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom
| | - Francesca Pugliese
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, United Kingdom; Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry, Queen Mary University of London, United Kingdom.
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Kelham M, Mathur A, Jones DA. Response by Kelham et al to Letter Regarding Article, "Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial". Circulation 2024; 149:e1133. [PMID: 38683897 DOI: 10.1161/circulationaha.124.068825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Matthew Kelham
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry (M.K., A.M., D.A.J.)
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (M.K., A.M., D.A.J.)
- Queen Mary University of London. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London (M.K., A.M., D.A.J.)
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry (M.K., A.M., D.A.J.)
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (M.K., A.M., D.A.J.)
- Queen Mary University of London. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London (M.K., A.M., D.A.J.)
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Faculty of Medicine & Dentistry (M.K., A.M., D.A.J.)
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (M.K., A.M., D.A.J.)
- Barts Cardiovascular Clinical Trials Unit, Faculty of Medicine & Dentistry (D.A.J.)
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Jones DA, Beirne AM, Kelham M, Wynne L, Andiapen M, Rathod KS, Parakaw T, Adams J, Learoyd A, Khan K, Godec T, Wright P, Antoniou S, Wragg A, Yaqoob M, Mathur A, Ahluwalia A. Inorganic nitrate benefits contrast-induced nephropathy after coronary angiography for acute coronary syndromes: the NITRATE-CIN trial. Eur Heart J 2024:ehae100. [PMID: 38513060 DOI: 10.1093/eurheartj/ehae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/18/2024] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND AND AIMS Contrast-induced nephropathy (CIN), also known as contrast-associated acute kidney injury (CA-AKI) underlies a significant proportion of the morbidity and mortality following coronary angiographic procedures in high-risk patients and remains a significant unmet need. In pre-clinical studies inorganic nitrate, which is chemically reduced in vivo to nitric oxide, is renoprotective but this observation is yet to be translated clinically. In this study, the efficacy of inorganic nitrate in the prevention of CIN in high-risk patients presenting with acute coronary syndromes (ACS) is reported. METHODS NITRATE-CIN is a double-blind, randomized, single-centre, placebo-controlled trial assessing efficacy of inorganic nitrate in CIN prevention in at-risk patients presenting with ACS. Patients were randomized 1:1 to once daily potassium nitrate (12 mmol) or placebo (potassium chloride) capsules for 5 days. The primary endpoint was CIN (KDIGO criteria). Secondary outcomes included kidney function [estimated glomerular filtration rate (eGFR)] at 3 months, rates of procedural myocardial infarction, and major adverse cardiac events (MACE) at 12 months. This study is registered with ClinicalTrials.gov: NCT03627130. RESULTS Over 3 years, 640 patients were randomized with a median follow-up of 1.0 years, 319 received inorganic nitrate with 321 received placebo. The mean age of trial participants was 71.0 years, with 73.3% male and 75.2% Caucasian; 45.9% had diabetes, 56.0% had chronic kidney disease (eGFR <60 mL/min) and the mean Mehran score of the population was 10. Inorganic nitrate treatment significantly reduced CIN rates (9.1%) vs. placebo (30.5%, P < .001). This difference persisted after adjustment for baseline creatinine and diabetes status (odds ratio 0.21, 95% confidence interval 0.13-0.34). Secondary outcomes were improved with inorganic nitrate, with lower rates of procedural myocardial infarction (2.7% vs. 12.5%, P = .003), improved 3-month renal function (between-group change in eGFR 5.17, 95% CI 2.94-7.39) and reduced 1-year MACE (9.1% vs. 18.1%, P = .001) vs. placebo. CONCLUSIONS In patients at risk of renal injury undergoing coronary angiography for ACS, a short (5 day) course of once-daily inorganic nitrate reduced CIN, improved kidney outcomes at 3 months, and MACE events at 1 year compared to placebo.
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Affiliation(s)
- Daniel A Jones
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Anne-Marie Beirne
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Matthew Kelham
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Lucinda Wynne
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mervyn Andiapen
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Krishnaraj S Rathod
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Tipparat Parakaw
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
| | - Jessica Adams
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Annastazia Learoyd
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Kamran Khan
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Thomas Godec
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andrew Wragg
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Muhammad Yaqoob
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Amrita Ahluwalia
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1 M 6BQ, UK
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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James S, Erlinge D, Storey RF, McGuire DK, de Belder M, Eriksson N, Andersen K, Austin D, Arefalk G, Carrick D, Hofmann R, Hoole SP, Jones DA, Lee K, Tygesen H, Johansson PA, Langkilde AM, Ridderstråle W, Parvaresh Rizi E, Deanfield J, Oldgren J. Dapagliflozin in Myocardial Infarction without Diabetes or Heart Failure. NEJM Evid 2024; 3:EVIDoa2300286. [PMID: 38320489 DOI: 10.1056/evidoa2300286] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Dapagliflozin in Myocardial InfarctionA total of 4017 patients with acute myocardial infarction, but no diabetes or chronic heart failure, were randomly assigned 10 mg of dapagliflozin or placebo. The primary outcome was a composite of death, hospitalization for heart failure, and five cardiometabolic outcomes analyzed using the win ratio method. There were significantly more wins for dapagliflozin than for placebo (win ratio, 1.34; 95% confidence interval, 1.20 to 1.50), which was driven by the cardiometabolic outcomes. The composite of time to cardiovascular death/hospitalization for heart failure was not different between the two groups.
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Affiliation(s)
- Stefan James
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Robert F Storey
- Cardiovascular Research Unit, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Division of Cardiology, Parkland Health and Hospital System, Dallas
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), NHS Arden & GEM Commissioning Support Unit, Leicester, United Kingdom
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Kasper Andersen
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
| | - David Austin
- Academic Cardiovascular Unit, The James Cook University Hospital, South Tees NHS FT, Middlesbrough, United Kingdom
- Population Health Science Institute, Newcastle University, Newcastle, United Kingdom
| | - Gabriel Arefalk
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
- Thoracic Center, Blekinge Hospital, Karlskrona, Sweden
| | - David Carrick
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Cardiology, University Hospital Hairmyres, East Kilbride, United Kingdom
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm
| | - Stephen P Hoole
- Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Daniel A Jones
- William Harvey Research Institute, Barts & The London Faculty of Medicine & Dentistry, Queen Mary University of London, London
- Department of Cardiology, St. Bartholomew's Hospital, West Smithfield, London
| | - Kelvin Lee
- Lincolnshire Heart Centre, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
- School of Life Sciences, University of Lincoln, Lincoln, United Kingdom
| | - Hans Tygesen
- Department of Medicine, South Älvsborg Hospital, Borås, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Peter A Johansson
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Wilhelm Ridderstråle
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Ehsan Parvaresh Rizi
- Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London
| | - Jonas Oldgren
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Jones DA, Beirne AM, Kelham M, Rathod KS, Andiapen M, Wynne L, Godec T, Forooghi N, Ramaseshan R, Moon JC, Davies C, Bourantas CV, Baumbach A, Manisty C, Wragg A, Ahluwalia A, Pugliese F, Mathur A. Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial. Circulation 2023; 148:1371-1380. [PMID: 37772419 DOI: 10.1161/circulationaha.123.064465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, but this has not been tested in a randomized controlled trial. METHODS This study was a single-center, open-label randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Patients were randomized 1:1 to undergo CTCA before ICA or ICA alone. The co-primary end points were procedural duration of the ICA (defined as the interval between local anesthesia administration for obtaining vascular access and removal of the last catheter), patient satisfaction after ICA using a validated questionnaire, and the incidence of contrast-induced nephropathy. Linear regression was used for procedural duration and patient satisfaction score; contrast-induced nephropathy was analyzed using logistic regression. We applied the Bonferroni correction, with P<0.017 considered significant and 98.33% CIs presented. Secondary end points included incidence of procedural complications and 1-year major adverse cardiac events. RESULTS Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, -23.5 to -18.4]; P<0.001), alongside improved mean ICA satisfaction scores (1=very good to 5=very poor; -1.1 difference [98.33% CI, -1.2 to -0.9]; P<0.001), and reduced incidence of contrast-induced nephropathy (3.4% versus 27.9%; odds ratio, 0.09 [98.33% CI, 0.04-0.2]; P<0.001). Procedural complications (2.3% versus 10.8%; odds ratio, 0.2 [95% CI, 0.1-0.4]; P<0.001) and 1-year major adverse cardiac events (16.0% versus 29.4%; hazard ratio, 0.4 [95% CI, 0.3-0.6]; P<0.001) were also lower in the CTCA+ICA group. CONCLUSIONS For patients with previous coronary artery bypass grafting, CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, with improved patient satisfaction. CTCA before ICA should be considered in this group of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03736018.
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Affiliation(s)
- Daniel A Jones
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Matthew Kelham
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Lucinda Wynne
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Thomas Godec
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Nasim Forooghi
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Rohini Ramaseshan
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - James C Moon
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ceri Davies
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Christos V Bourantas
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Charlotte Manisty
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andrew Wragg
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Francesca Pugliese
- Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
- Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK
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Choudry FA, Jones DA, Archbold RA. Hospitalisation due to acute cardiovascular conditions: is screening for recreational drug use justified? Heart 2023; 109:1582-1583. [PMID: 37582634 DOI: 10.1136/heartjnl-2023-322808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Affiliation(s)
- Fizzah A Choudry
- General & Invasive Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Centre for Cardiovascular Medicine and Devices, Queen Mary University of London, London, UK
| | - Daniel A Jones
- General & Invasive Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
- Centre for Cardiovascular Medicine and Devices, Queen Mary University of London, London, UK
| | - R Andrew Archbold
- General & Invasive Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
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Stirnemann J, Besson R, Debavelaere V, Loge F, Amabile C, Migeon P, Curran MA, Fries N, Smith E, Ostermayer E, Bradley KE, Armstrong L, Trychon K, Sheehan K, Flinn M, Rodriguez DA, Spiliopoulos M, Romero V, Jones DA, Allbert JR, Ghulmiyyah L, Spaggiari E, Ville Y. Abstracts of the 33rd World Congress on Ultrasound in Obstetrics and Gynecology, 16-19 October 2023, Seoul, South Korea. Ultrasound Obstet Gynecol 2023; 62 Suppl 1:1-316. [PMID: 37779444 DOI: 10.1002/uog.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Affiliation(s)
- J Stirnemann
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | | | | | | | | | | | - M A Curran
- Division of Maternal-Fetal Medicine, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - N Fries
- Collège Français d'Echographie Fetale, Paris, France
| | - E Smith
- BovenMaas, Rotterdam, Netherlands
| | - E Ostermayer
- Pränatalmedizin 5-Seen-Land, Seefeld-Hechendorf, Germany
| | - K E Bradley
- Private Practice, Westlake, Village, CA, USA
| | - L Armstrong
- UNC Southeastern Maternal-Fetal Medicine, Lumberton, NC, USA
| | - K Trychon
- Center for Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Sheehan
- Obstetrics and Gynecology, Private Practice, Ridgewood, NJ, USA
| | - M Flinn
- Diagnostic Center of Arizona, Chandler, AZ, USA
| | | | - M Spiliopoulos
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - V Romero
- Maternal-Fetal Medicine, Corewell Health-West, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - D A Jones
- Perinatal Specialists of the Palm Beaches, West Palm Beach, FL, USA
| | - J R Allbert
- Maternal-Fetal Medicine Associates, Charlotte, NC, USA
| | - L Ghulmiyyah
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - E Spaggiari
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
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8
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Rathod KS, Teoh Z, Tyrlis A, Choudry FA, Hamshere SM, Comer K, Guttmann O, Jain AK, Ozkor MA, Wragg A, Archbold RA, Baumbach A, Mathur A, Jones DA. Thrombus Burden and Outcomes in Patients With COVID-19 Presenting With STEMI Across the Pandemic. J Am Coll Cardiol 2023; 81:2406-2416. [PMID: 37344042 DOI: 10.1016/j.jacc.2023.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND It has been previously reported during the first COVID-19 outbreak that patients presenting with ST-segment elevation myocardial infarction (STEMI) and concurrent COVID-19 infection have increased thrombus burden and poorer outcomes. To date, there have been no reports comparing the outcomes of COVID-19-positive STEMI patients across all waves of the pandemic. OBJECTIVES This study compared the baseline demographic, procedural, and angiographic characteristics alongside the clinical outcomes of patients presenting with STEMI and concurrent COVID-19 infection across the COVID-19 pandemic in the United Kingdom. METHODS This was a single-center, observational study of 1,269 consecutive patients admitted with confirmed STEMI treated with percutaneous coronary intervention (between January 3, 2020 and October 3, 2022). COVID-19-positive patients were split into 3 groups based upon the time course of the pandemic, and a comparison was made between waves. RESULTS A total of 154 COVID-19-positive patients with STEMI were included in the present analysis and were compared with 1,115 COVID-19-negative patients. Early during the pandemic (wave 1), STEMI patients presenting with concurrent COVID-19 infection had high rates of cardiac arrest, evidence of increased thrombus burden, bigger infarcts, and worse outcomes. However, by wave 3, no differences existed in outcomes between COVID-19-positive and -negative patients, with significant differences compared with earlier COVID-19-positive patients. Poor outcomes later in the study period were predominantly in unvaccinated individuals. CONCLUSIONS Significant changes have occurred in the clinical characteristics, angiographic features, and outcomes of STEMI patients with COVID-19 infection treated by primary percutaneous coronary intervention during the course of the pandemic. Importantly, outcomes of recent waves and in vaccinated individuals are no different to a non-COVID-19 population.
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Affiliation(s)
- Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Zhi Teoh
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Angelos Tyrlis
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Fizzah A Choudry
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Stephen M Hamshere
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Katrina Comer
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Oliver Guttmann
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Ajay K Jain
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Muhiddin A Ozkor
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andrew Wragg
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - R Andrew Archbold
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
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9
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Teoh Z, Rathod KS, Comer K, Tyrlis A, Choudry FA, Ozkor M, Archbold RA, Guttmann O, Wragg A, Baumbach A, Jain AK, Mathur A, Jones DA. The safety of deferred coronary angiography in COVID-19 patients with acute coronary syndrome: the Barts COVID recovered pathway. Am J Cardiovasc Dis 2023; 13:168-176. [PMID: 37469533 PMCID: PMC10352812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To assess the safety and effectiveness of a novel pathway of deferrred invasive angiography in low-risk NSTEMI patients with concurrent COVID-19 infections; contrary to current UK guidelines recommending invasive coronary angiography in NSTEMI patients within 72 hours. METHODS This was a single-centre, observational study of all NSTEMI patients referred for inpatient coronary angiography at Barts Heart Centre, between March 2020 and June 2022. Demographic, procedural and outcome data were collected as part of a national cardiac audit. RESULTS 201 COVID positive NSTEMI patients were referred for angiography at Barts Heart Centre. 10 patients died from COVID related respiratory complications prior to angiography. Therefore, 191 patients underwent deferred angiography (median time 16 days from COVID diagnosis). The median GRACE score was 128 (IQR 86-153). Troponin levels were significantly elevated on initial COVID diagnosis compared to time of their procedure. 73% patients had a culprit lesion identified. 61.2% receiving PCI. Patients were followed-up for a median of 363 days (IQR 120-485 days) with MACE rates of 7.3%. This is comparable to the MACE event for NSTEMI patients (n=4529) without COVID at our institution treated during the same time-period (8.1%). CONCLUSION This study demonstrates the safety and effectiveness of deferred coronary angiography on a COVID-Recovered pathway after a period of medical management for patients presenting with NSTEMI and concurrent COVID-19 infection. There was no adverse signal associated with the wait for angiography with similar MACE rates to the non-deferred NSTEMI cohort without COVID-19.
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Affiliation(s)
- Zhi Teoh
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon, UK
| | - Katrina Comer
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Angelos Tyrlis
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Fizzah A Choudry
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Mick Ozkor
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - R Andrew Archbold
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Oliver Guttmann
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Andrew Wragg
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Andreas Baumbach
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon, UK
| | - Ajay K Jain
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon, UK
| | - Daniel A Jones
- Barts Intervention Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s HospitalWest Smithfield, London, EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon, UK
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Jones J, Mouyis K, Tyrlis A, Rathod KS, Guttmann O, Wragg A, O'Mahony C, Mathur A, Baumbach A, Jones DA. An observational study assessing the use of Sirolimus-eluting balloons for side-branch treatment in the provisional stenting of coronary bifurcations. Am Heart J Plus 2023; 30:100301. [PMID: 38510922 PMCID: PMC10945945 DOI: 10.1016/j.ahjo.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 03/22/2024]
Abstract
Background Drug eluting balloons (DEB) are a feasible method of rapid delivery of drug to a coronary vessel wall. Their efficacy has been established for the treatment of in-stent restenosis and small vessel disease but there is limited data for their use in bifurcation lesions. Objective The aim of this study was to assess the effectiveness of provisional upfront side-branch DEB use in bifurcation lesions compared to a simple balloon (POBA) or upfront 2 stent bifurcation strategy. Methods We conducted an observational study of 625 patients undergoing PCI to bifurcation lesions. All the patients had a DES deployed in the main vessel (MV). Decision on revascularization option for the side branch (SB) was made by the operator. The primary endpoint was target vessel failure. Secondary endpoints were target vessel myocardial infarction and all-cause mortality. Results 311 patients had upfront DEB to the SB whilst the remaining were treated with either DES (188) or POBA (126). Baseline characteristics were similar aside from history of previous MI, which were higher in patients treated with DES or POBA, p = 0.009 whereas patients with previous CABG were likely to undergo DEB treatment (p = 0.004). TVF was more likely to occur in the POBA group (7.5 %) compared to the DEB (3.3 %) and DES (3.3 %) groups (p = 0.0019). There was no significant difference in TV-MI (p = 0.62) or death (p = 0.98) between the groups. Conclusion This study suggests that provisional bifurcation stenting with upfront Sirolimus DEB use in the SB is an effective treatment for non-LMS bifurcation PCI.
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Affiliation(s)
- Johanna Jones
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kyriacos Mouyis
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Angelos Tyrlis
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Krishnaraj S. Rathod
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Oliver Guttmann
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Andrew Wragg
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Constantinos O'Mahony
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anthony Mathur
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Andreas Baumbach
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Daniel A. Jones
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
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Reid A, Hussain M, Veerapen J, Ramaseshan R, Hall R, Bowles R, Jones DA, Mathur A. DCM Support: cell therapy and circulatory support for dilated cardiomyopathy patients with severe ventricular impairment. ESC Heart Fail 2023. [PMID: 37190883 PMCID: PMC10375109 DOI: 10.1002/ehf2.14393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
AIMS The DCM Support trial (NCT03572660) uses a percutaneous circulatory support device (Impella CP, Abiomed, Danvers, MA, USA) to improve the safety of an intracoronary cell infusion procedure in patients with dilated cardiomyopathy (DCM) and a severely reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS DCM Support is a single-site, single-arm Phase II trial enrolling 20 symptomatic DCM patients with an LVEF ≤ 35% despite optimal medical and device therapy. After 5 days of granulocyte colony-stimulating factor therapy and a subsequent bone marrow aspiration, patients undergo an intracoronary infusion of autologous bone-marrow-derived mononuclear cells. The Impella CP device is used to provide haemodynamic support during the infusion procedure. The trial's primary endpoint is change in LVEF from baseline at 3 months. Secondary efficacy endpoints are change in LVEF from baseline at 12 months, and change in exercise capacity, New York Heart Association class, quality of life, and N-terminal pro-B-type natriuretic peptide levels from baseline at 3 and 12 months. Safety endpoints include procedural safety and major adverse cardiac events at 3 and 12 months. CONCLUSIONS This is the first trial to assess the safety and efficacy of cytokine and autologous intracoronary cell therapy with a procedural circulatory support device for patients with severe left ventricular impairment. This novel combination may allow us to target a patient population most at need of this therapy.
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Affiliation(s)
- Alice Reid
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, London, EC1M 6BQ, United Kingdom
| | - Mohsin Hussain
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jessry Veerapen
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Rohini Ramaseshan
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Russell Hall
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ruth Bowles
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, London, EC1M 6BQ, United Kingdom
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, London, EC1M 6BQ, United Kingdom
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12
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Jones DA, Candio P, Shakir R, Ramroth J, Wolstenholme J, Gray AM, Cutter DJ, Ntentas G. Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma. Clin Oncol (R Coll Radiol) 2023; 35:301-310. [PMID: 36732121 DOI: 10.1016/j.clon.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
AIMS Radiotherapy for Hodgkin lymphoma leads to the irradiation of organs at risk (OAR), which may confer excess risks of late effects. Comparative dosimetry studies show that proton beam therapy (PBT) may reduce OAR irradiation compared with photon radiotherapy, but PBT is more expensive and treatment capacity is limited. The purpose of this study is to inform the appropriateness of PBT for intermediate-stage Hodgkin lymphoma (ISHL). MATERIALS AND METHODS A microsimulation model simulating the course of ISHL, background mortality and late effects was used to estimate comparative quality-adjusted life years (QALYs) lived and healthcare costs after consolidative pencil beam scanning PBT or volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold. Outcomes were compared for 606 illustrative patients covering a spectrum of clinical presentations, varying by two age strata (20 and 40 years), both sexes, three smoking statuses (never, former and current) and 61 pairs of OAR radiation doses from a comparative planning study. Both undiscounted and discounted outcomes at 3.5% yearly discount were estimated. The maximum excess cost of PBT that might be considered cost-effective by the UK's National Institute for Health and Care Excellence was calculated. RESULTS OAR doses, smoking status and discount rate had large impacts on QALYs gained with PBT. Current smokers benefited the most, averaging 0.605 undiscounted QALYs (range -0.341 to 2.171) and 0.146 discounted QALYs (range -0.067 to 0.686), whereas never smokers benefited the least, averaging 0.074 undiscounted QALYs (range -0.196 to 0.491) and 0.017 discounted QALYs (range -0.030 to 0.086). For the gain in discounted QALYs to be considered cost-effective, PBT would have to cost at most £4812 more than VMAT for current smokers and £645 more for never smokers. This is below preliminary National Health Service cost estimates of PBT over photon radiotherapy. CONCLUSION In a UK setting, PBT for ISHL may not be considered cost-effective. However, the degree of unquantifiable uncertainty is substantial.
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Affiliation(s)
- D A Jones
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK.
| | - P Candio
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Economics and Management, University of Trento, Trento, Italy
| | - R Shakir
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Ramroth
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - A M Gray
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - D J Cutter
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G Ntentas
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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13
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Broughton N, Comer K, Casey-Gillman O, Moore L, Antoniou S, Patel R, Fhadil S, Wright P, Ozkor M, Guttmann O, Baumbach A, Wragg A, Jain AJ, Choudry F, Mathur A, Rathod KS, Jones DA. An exploration of the early discharge approach for low-risk STEMI patients following primary percutaneous coronary intervention. Am J Cardiovasc Dis 2023; 13:32-42. [PMID: 37213314 PMCID: PMC10193248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
Recently, there has been growing interest in the early discharge strategy for low-risk patients who have undergone primary percutaneous coronary intervention (PCI) to treat ST-segment elevation myocardial infarction (STEMI). So far findings have suggested there are multiple advantages of shorter hospital stays, including that it could be a safe way to be more cost- and resource-efficient, reduce cases of hospital-acquired infection and boost patient satisfaction. However, there are remaining concerns surrounding safety, patient education, adequate follow-up and the generalisability of the findings from current studies which are mostly small-scale. By assessing the current research, we describe the advantages, disadvantages and challenges of early hospital discharge for STEMI and discuss the factors that determine if a patient can be considered low risk. If it is feasible to safely employ a strategy like this, the implications for healthcare systems worldwide could be extremely beneficial, particularly in lower-income economies and when we consider the detrimental impacts of the recent COVID-19 pandemic on healthcare systems.
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Affiliation(s)
- Nicole Broughton
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
| | - Katrina Comer
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Oliver Casey-Gillman
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Lizze Moore
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Riyaz Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Sadeer Fhadil
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Muhiddin Ozkor
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Oliver Guttmann
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Ajay J Jain
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Fizzah Choudry
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of LondonLondon EC1A 7BE, UK
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
- Department of Cardiology, Barts Heart Centre, Barts Health NHS TrustLondon EC1A 7BE, UK
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14
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De Luca G, Silverio A, Verdoia M, Siudak Z, Tokarek T, Kite TA, Gershlick AH, Rodriguez-Leor O, Cid-Alvarez B, Jones DA, Rathod KS, Montero-Cabezas JM, Jurado-Roman A, Nardin M, Galasso G. Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies. Eur J Intern Med 2022; 105:69-76. [PMID: 35999094 PMCID: PMC9385833 DOI: 10.1016/j.ejim.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known. METHODS The PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow. RESULTS Of 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (pinteraction = 0.001) and secondary outcome (pinteraction = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77-18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64-52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84-42.80) were independent predictors of mortality. CONCLUSIONS In STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population.
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, Azienda Ospedaliero-Universitaria Sassari, Viale S. Pietro, 43/B, Sassari 07100, Italy; Division of Clinical and Interventional Cardiology, Istituto Clinico Sant'Ambrogio, Milano, Italy.
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy
| | | | - Tomasz Tokarek
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, Kraków 31-501, Poland; 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Oriol Rodriguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Belen Cid-Alvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
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15
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Sim DS, Jones DA, Davies C, Locca D, Veerapen J, Reid A, Godec T, Martin J, Mathur A. Cell administration routes for heart failure: a comparative re-evaluation of the REGENERATE-DCM and REGENERATE-IHD trials. Regen Med 2022; 17:891-903. [PMID: 36226504 DOI: 10.2217/rme-2022-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: Given the logistical issues surrounding intramyocardial cell delivery, we sought to address the efficacy of the simpler, more accessible intracoronary route by re-evaluating REGENERATE-DCM and REGENERATE-IHD (autologous cell therapy trials for heart failure; n = 150). Methods: A retrospective statistical analysis was performed on the trials' combined data. The following end points were evaluated: left ventricular ejection fraction (LVEF), N-terminal pro brain natriuretic peptide concentration (NT-proBNP), New York Heart Association class (NYHA) and quality of life. Results: This demonstrated a new efficacy signal for intracoronary delivery, with significant benefits to: LVEF (3.7%; p = 0.01), NT-proBNP (median -76 pg/ml; p = 0.04), NYHA class (48% patients; p = 0.01) and quality of life (12 ± 19; p = 0.006). The improvements in LVEF, NYHA and quality of life scores remained significant compared to the control group. Conclusion: The efficacy and logistical simplicity of intracoronary delivery should be taken into consideration for future trials.
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Affiliation(s)
- Doo Sun Sim
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwanjgu, Republic of Korea
| | - Daniel A Jones
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Interventional Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ceri Davies
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Interventional Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Didier Locca
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jessry Veerapen
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Interventional Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Alice Reid
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Thomas Godec
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Cardiovascular Clinical Trials Unit, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Anthony Mathur
- Centre for Cardiovascular Medicine & Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Interventional Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
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16
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Hall RC, Ramaseshan R, Reid A, Jones DA, Mathur A. Case report: Cytokine therapy and an intracoronary autologous bone marrow-derived cell infusion with Impella support in a patient with dilated cardiomyopathy and a severely reduced ejection fraction. Front Cardiovasc Med 2022; 9:1002508. [PMID: 36172585 PMCID: PMC9510980 DOI: 10.3389/fcvm.2022.1002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction This is the first reported case of a patient with dilated cardiomyopathy (DCM) and severely impaired left ventricular function to receive a combined treatment of granulocyte colony-stimulating factor therapy and an intracoronary delivery of autologous bone marrow-derived mononuclear cells with percutaneous circulatory assistance (the Impella CP device; Abiomed, Danvers, MA). Main symptoms and outcome Three months post-treatment, the gentleman in his early 70s demonstrated an improvement in left ventricular ejection fraction (13–17%) and a reduction in New York Heart Association class from III to class I. There was also an improvement in his 6-minute walk test (147–357 meters), N-terminal pro-brain natriuretic peptide level (14,099–7,129 ng/l) and quality of life scores. There were no safety concerns during the treatment or follow-up. Conclusion This case report suggests combined cell and cytokine therapy with adjunctive circulatory support could be a safe and promising treatment for patients with DCM and severely reduced ejection fraction.
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Affiliation(s)
| | - Rohini Ramaseshan
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Alice Reid
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Daniel A. Jones
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anthony Mathur
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- *Correspondence: Anthony Mathur
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17
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Bajaj R, Ramasamy A, Brown JT, Koganti S, Little C, Rathod KS, Jones DA, Rees P, Guttmann O, Lockie T, Ozkor M, Mathur A, Kalra SS, Baumbach A, Bourantas CV, Rakhit R, O'Mahony C. Treatment Strategies and Outcomes of Emergency Left Main Percutaneous Coronary Intervention. Am J Cardiol 2022; 177:1-6. [PMID: 35732552 DOI: 10.1016/j.amjcard.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
Emergency percutaneous coronary intervention of the left main (LM ePCI) coronary artery necessitated by acute coronary syndrome is associated with a high risk of mortality. However, optimal treatment strategies and related outcomes remain undefined in this group. We undertook a multi-center, retrospective, observational cohort study of consecutive patients requiring LM ePCI between 2011 and 2018 and reported the coronary anatomy, treatment strategies, outcomes, and predictors of mortality. A total of 116 consecutive cases were included. Patients were predominantly male (85%) with a median age of 68.0 years; 12 patients (10%) had previous coronary artery bypass grafting. ST-elevation was noted in 76 (66%); 30 (26%) presented with an out-of-hospital cardiac arrest (OOHCA) and 47 (41%) with cardiogenic shock. The most frequent pattern of disease was Medina 1,1,1, seen in 59 patients (51%). The commonest revascularization strategy was provisional stenting (95 cases, 82%) with improved or thrombolysis in myocardial infarction 3 flow seen in 85 cases (73%). All-cause mortality was 35% at 30 days, rising to 58% at 5 years. Adverse predictors of 30-day mortality included presentation with cardiogenic shock (p = 0.018) and OOHCA (p = 0.020), whereas improved flow and/or thrombolysis in myocardial infarction 3 flow in both circumflex and left anterior descending artery afforded a better prognosis (p = 0.028). In conclusion, patients who underwent LM ePCI are a high-risk subgroup and commonly present with cardiogenic shock and OOHCA. Provisional stenting appears to be the preferred option with the successful restoration of coronary flow in most cases despite complex anatomy. High 30-day mortality is driven by the presence of cardiogenic shock, OOHCA, and failure to restore or improve coronary flow.
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Affiliation(s)
- Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - James T Brown
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; National Pulmonary Hypertension Service; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sudheer Koganti
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom; Citizens Specialty Hospital, Hyderabad, India
| | - Callum Little
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Paul Rees
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Oliver Guttmann
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Tim Lockie
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mick Ozkor
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Sundeep S Kalra
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Constantinos O'Mahony
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
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Jones DA, Rathod KS, Mathur A, Archbold RA. Discharge after primary percutaneous coronary intervention: the earlier the better? Eur Heart J Qual Care Clin Outcomes 2022; 8:229-231. [PMID: 34951919 DOI: 10.1093/ehjqcco/qcab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022]
Affiliation(s)
- D A Jones
- Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK.,Barts NIHR Biomedical Research Centre, Barts and The London Medical School, Queen Mary University, London, UK.,Barts Interventional Group, Interventional Cardiology, Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - K S Rathod
- Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK.,Barts NIHR Biomedical Research Centre, Barts and The London Medical School, Queen Mary University, London, UK.,Barts Interventional Group, Interventional Cardiology, Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - A Mathur
- Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK.,Barts NIHR Biomedical Research Centre, Barts and The London Medical School, Queen Mary University, London, UK.,Barts Interventional Group, Interventional Cardiology, Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - R A Archbold
- Barts Interventional Group, Interventional Cardiology, Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
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Choudry FA, Rathod KS, Baumbach A, Mathur A, Jones DA. Long-term outcomes of COVID-19 associated ST-elevation myocardial infarction treated with primary PCI. Cardiovascular Revascularization Medicine 2022; 43:133-135. [PMID: 35637125 PMCID: PMC9132431 DOI: 10.1016/j.carrev.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022]
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Seraphim A, Dowsing B, Rathod KS, Shiwani H, Patel K, Knott KD, Zaman S, Johns I, Razvi Y, Patel R, Xue H, Jones DA, Fontana M, Cole G, Uppal R, Davies R, Moon JC, Kellman P, Manisty C. Quantitative Myocardial Perfusion Predicts Outcomes in Patients With Prior Surgical Revascularization. J Am Coll Cardiol 2022; 79:1141-1151. [PMID: 35331408 PMCID: PMC9034686 DOI: 10.1016/j.jacc.2021.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with previous coronary artery bypass graft (CABG) surgery typically have complex coronary disease and remain at high risk of adverse events. Quantitative myocardial perfusion indices predict outcomes in native vessel disease, but their prognostic performance in patients with prior CABG is unknown. OBJECTIVES In this study, we sought to evaluate whether global stress myocardial blood flow (MBF) and perfusion reserve (MPR) derived from perfusion mapping cardiac magnetic resonance (CMR) independently predict adverse outcomes in patients with prior CABG. METHODS This was a retrospective analysis of consecutive patients with prior CABG referred for adenosine stress perfusion CMR. Perfusion mapping was performed in-line with automated quantification of MBF. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events defined as nonfatal myocardial infarction and unplanned revascularization. Associations were evaluated with the use of Cox proportional hazards models after adjusting for comorbidities and CMR parameters. RESULTS A total of 341 patients (median age 67 years, 86% male) were included. Over a median follow-up of 638 days (IQR: 367-976 days), 81 patients (24%) reached the primary outcome. Both stress MBF and MPR independently predicted outcomes after adjusting for known prognostic factors (regional ischemia, infarction). The adjusted hazard ratio (HR) for 1 mL/g/min of decrease in stress MBF was 2.56 (95% CI: 1.45-4.35) and for 1 unit of decrease in MPR was 1.61 (95% CI: 1.08-2.38). CONCLUSIONS Global stress MBF and MPR derived from perfusion CMR independently predict adverse outcomes in patients with previous CABG. This effect is independent from the presence of regional ischemia on visual assessment and the extent of previous infarction.
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Affiliation(s)
- Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom. https://twitter.com/andreas_sera
| | - Benjamin Dowsing
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Krishnaraj S Rathod
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Hunain Shiwani
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Kush Patel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sameer Zaman
- Imperial College London, Imperial College, Healthcare NHS Trust, South Kensington, London, United Kingdom
| | - Ieuan Johns
- Imperial College London, Imperial College, Healthcare NHS Trust, South Kensington, London, United Kingdom
| | | | | | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel A Jones
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Royal Free Hospital, London, United Kingdom
| | | | - Rakesh Uppal
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Rhodri Davies
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom.
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Jones J, Rathod KS, Beirne AM, Hamshere SM, Choudry FA, O'Mahony C, Guttmann OP, Knight CJ, Amersey R, Wragg A, Baumbach A, Mathur A, Jones DA. An observational study assessing the predictors of procedural failure from the radial approach. Is right radial access always the best? Cardiovascular Revascularization Medicine 2022; 42:86-91. [DOI: 10.1016/j.carrev.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
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Mathur A, Sim DS, Choudry F, Veerapen J, Colicchia M, Turlejski T, Hussain M, Hamshere S, Locca D, Rakhit R, Crake T, Kastrup J, Agrawal S, Jones DA, Martin J. Five‐year follow‐up of intracoronary autologous cell therapy in acute myocardial infarction: the REGENERATE‐AMI trial. ESC Heart Fail 2022; 9:1152-1159. [PMID: 35043578 PMCID: PMC8934988 DOI: 10.1002/ehf2.13786] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
Aims The long‐term outcomes of the intracoronary delivery of autologous bone marrow‐derived cells (BMCs) after acute myocardial infarction are not well established. Following the promising 1 year results of the REGENERATE‐AMI trial (despite it not achieving its primary endpoint), this paper presents the analysis of the 5 year clinical outcomes of these acute myocardial infarction patients who were treated with an early intracoronary autologous BMC infusion or placebo. Methods and results A 5 year follow‐up of major adverse cardiac events (defined as the composite of all‐cause death, recurrent myocardial infarction, and all coronary revascularization) and of rehospitalization for heart failure was completed in 85 patients (BMC n = 46 and placebo n = 39). The incidence of major adverse cardiac events was similar between the BMC‐treated patients and the placebo group (26.1% vs. 18.0%, P = 0.41). There were no cases of cardiac death in either group, but an increase in non‐cardiac death was seen in the BMC group (6.5% vs. 0%, P = 0.11). The rates of recurrent myocardial infarction and repeat revascularization were similar between the two groups. There were no cases of rehospitalization for heart failure in either group. Conclusion This 5 year follow‐up analysis of the REGENERATE‐AMI trial did not show an improvement in clinical outcomes for patients treated with cell therapy. This contrasts with the 1 year results which showed improvements in the surrogate outcome measures of ejection fraction and myocardial salvage index.
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Affiliation(s)
- Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Doo Sun Sim
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- Department of Cardiovascular Medicine Chonnam National University Hospital, Chonnam National University School of Medicine Gwangju Korea
| | - Fizzah Choudry
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Jessry Veerapen
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Martina Colicchia
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Tymoteusz Turlejski
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Mohsin Hussain
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Stephen Hamshere
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Didier Locca
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- École Polytechnique Fédérale de Lausanne Lausanne Switzerland
| | - Roby Rakhit
- Department of Cardiology The Royal Free Hospital, Royal Free London Foundation Trust London UK
| | - Tom Crake
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
| | - Jens Kastrup
- Rigshospitalet and University of Copenhagen Copenhagen Denmark
| | - Samir Agrawal
- Haemato‐Oncology, Barts Health NHS Trust & Immunobiology, Blizard Institute Queen Mary University of London London UK
| | - Daniel A. Jones
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute Queen Mary University of London London UK
- Department of Cardiology Barts Heart Centre, Barts Health NHS Trust London UK
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Seraphim A, Knott KD, Augusto JB, Menacho K, Tyebally S, Dowsing B, Bhattacharyya S, Menezes LJ, Jones DA, Uppal R, Moon JC, Manisty C. Non-invasive Ischaemia Testing in Patients With Prior Coronary Artery Bypass Graft Surgery: Technical Challenges, Limitations, and Future Directions. Front Cardiovasc Med 2022; 8:795195. [PMID: 35004905 PMCID: PMC8733203 DOI: 10.3389/fcvm.2021.795195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 01/09/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery effectively relieves symptoms and improves outcomes. However, patients undergoing CABG surgery typically have advanced coronary atherosclerotic disease and remain at high risk for symptom recurrence and adverse events. Functional non-invasive testing for ischaemia is commonly used as a gatekeeper for invasive coronary and graft angiography, and for guiding subsequent revascularisation decisions. However, performing and interpreting non-invasive ischaemia testing in patients post CABG is challenging, irrespective of the imaging modality used. Multiple factors including advanced multi-vessel native vessel disease, variability in coronary hemodynamics post-surgery, differences in graft lengths and vasomotor properties, and complex myocardial scar morphology are only some of the pathophysiological mechanisms that complicate ischaemia evaluation in this patient population. Systematic assessment of the impact of these challenges in relation to each imaging modality may help optimize diagnostic test selection by incorporating clinical information and individual patient characteristics. At the same time, recent technological advances in cardiac imaging including improvements in image quality, wider availability of quantitative techniques for measuring myocardial blood flow and the introduction of artificial intelligence-based approaches for image analysis offer the opportunity to re-evaluate the value of ischaemia testing, providing new insights into the pathophysiological processes that determine outcomes in this patient population.
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Affiliation(s)
- Andreas Seraphim
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Kristopher D Knott
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Joao B Augusto
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Katia Menacho
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sara Tyebally
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom
| | - Benjamin Dowsing
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sanjeev Bhattacharyya
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom
| | - Leon J Menezes
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Rakesh Uppal
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - James C Moon
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- Department of Cardiac Imaging, Barts Health National Health System Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
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Rathod KS, Comer K, Casey-Gillman O, Moore L, Mills G, Ferguson G, Antoniou S, Patel R, Fhadil S, Damani T, Wright P, Ozkor M, Das D, Guttmann OP, Baumbach A, Archbold RA, Wragg A, Jain AK, Choudry FA, Mathur A, Jones DA. Early Hospital Discharge Following PCI for Patients With STEMI. J Am Coll Cardiol 2021; 78:2550-2560. [PMID: 34915986 DOI: 10.1016/j.jacc.2021.09.1379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care. OBJECTIVES This study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients. METHODS Between March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in <48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months. RESULTS The median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (>30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses. CONCLUSIONS Selected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.
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Affiliation(s)
- Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Katrina Comer
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Oliver Casey-Gillman
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Lizzie Moore
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Gordon Mills
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Gordon Ferguson
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Riyaz Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Sadeer Fhadil
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Tasleem Damani
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mick Ozkor
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Debashish Das
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Oliver P Guttmann
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - R Andrew Archbold
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ajay K Jain
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Fizzah A Choudry
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, Willian Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
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25
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Jones TN, Kelham M, Rathod KS, Knight CJ, Proudfoot A, Jain AK, Wragg A, Ozkor M, Rees P, Guttmann O, Baumbach A, Mathur A, Jones DA. Validation of the CREST score for predicting circulatory-aetiology death in out-of-hospital cardiac arrest without STEMI. Am J Cardiovasc Dis 2021; 11:723-733. [PMID: 35116185 PMCID: PMC8784677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
AIMS The CREST tool was recently developed to stratify the risk of circulatory-aetiology death (CED) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation myocardial infarction (STEMI). We aimed to validate the CREST score using an external cohort and determine whether it could be improved by the addition of serum lactate on admission. METHODS The study involved the retrospective analysis of consecutive patients admitted to a single tertiary centre with OHCA of presumed cardiac origin over a 51-month period. The CREST score was calculated by attributing points to the following variables: Coronary artery disease (CAD), non-shockable Rhythm, Ejection fraction <30%, cardiogenic Shock at presentation and ischaemic Time ≥25 minutes. The primary endpoint was CED vs neurological aetiology death (NED) or survival. RESULTS Of 500 patients admitted with OHCA, 211 did not meet criteria for STEMI and were included. 115 patients died in hospital (71 NED, 44 CED). When analysed individually, CED was associated with all CREST variables other than a previous diagnosis of CAD. The CREST score accurately predicted CED with excellent discrimination (C-statistic 0.880, 95% CI 0.813-0.946) and calibration (Hosmer and Lemeshow P=0.948). Although an admission lactate ≥7 mmol/L also predicted CED, its addition to the CREST score (the C-AREST score) did not significantly improve the predictive ability (CS 0.885, 0.815-0.954, HS P=0.942, X2 difference in -2 log likelihood =0.326, P=0.850). CONCLUSION Our study is the first to independently validate the CREST score for predicting CED in patients presenting with OHCA without STEMI. Addition of lactate on admission did not improve its predictive ability.
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Affiliation(s)
- Timothy N Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Matthew Kelham
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon EC1M 6BQ, UK
| | - Charles J Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Alastair Proudfoot
- Department of Perioperative Medicine, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Ajay K Jain
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Andrew Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon EC1M 6BQ, UK
| | - Muhiddin Ozkor
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Paul Rees
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Oliver Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon EC1M 6BQ, UK
| | - Andreas Baumbach
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon EC1M 6BQ, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon EC1M 6BQ, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St. Bartholomew’s Hospital2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of LondonLondon EC1M 6BQ, UK
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Murphy T, Jones DA, Friebel R, Uchegbu I, Mohiddin SA, Petersen SE. A Cost Analysis of Cardiac Magnetic Resonance Imaging in the Diagnostic Pathway of Patients Presenting With Unexplained Acute Myocardial Injury and Culprit-Free Coronary Angiography. Front Cardiovasc Med 2021; 8:749668. [PMID: 34746264 PMCID: PMC8564112 DOI: 10.3389/fcvm.2021.749668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/27/2021] [Indexed: 12/13/2022] Open
Abstract
Aims: To determine financial implications of implementing cardiac magnetic resonance imaging (CMR) in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography. Methods and Results: We performed a focused cost-benefit analysis using a hypothetical population of 2,000 patients with unexplained acute myocardial injury and normal coronary angiography divided into two groups to receive either standard or CMR guided management over a 10-year period. As healthcare practice and costs considerably vary geographically and over time, an algorithm with 15 key variables was developed to permit user-defined calculations of cost-benefit and other analyses. Using current UK costs, routine use of CMR increases healthcare spending by 14% per patient in the first year. After 7 years, CMR guided practice is cost neutral, reducing cost by 3% per patient 10 years following presentation. In addition, CMR -guided therapy results in 7 fewer myocardial infarctions and 14 fewer major bleeding events per 1,000 patients over a 10-year period. The three most sensitive variables were, in decreasing order, the cost of CMR, the cost of ticagrelor and the percentage of the population with MI requiring DAPT. Conclusion: Routine use of CMR in patients with unexplained acute myocardial injury and normal coronary angiography is associated with cost reductions in the medium to long term. The initial higher cost of CMR is offset over time and delivers a more personalized and higher quality of care.
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Affiliation(s)
- Theodore Murphy
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Daniel A Jones
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Rocco Friebel
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ijeoma Uchegbu
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Saidi A Mohiddin
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
| | - Steffen E Petersen
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service (NHS) Trust, London, United Kingdom
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27
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Beirne AM, Rathod KS, Castle E, Andiapen M, Richards A, Bellin A, Hammond V, Godec T, Moon JC, Davies C, Bourantas CV, Wragg A, Ahluwalia A, Pugliese F, Mathur A, Jones DA. The BYPASS-CTCA Study: the value of Computed Tomography Cardiac Angiography (CTCA) in improving patient-related outcomes in patients with previous bypass operation undergoing invasive coronary angiography: Study Protocol of a Randomised Controlled Trial. Ann Transl Med 2021; 9:1395. [PMID: 34733947 PMCID: PMC8506557 DOI: 10.21037/atm-21-1455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022]
Abstract
Background Patients with ischaemic heart disease and previous coronary artery bypass grafting (CABG) often need coronary evaluation by means of invasive coronary angiography (ICA). ICA in such patients is technically more challenging and carries a higher risk of complications including kidney damage, myocardial infarction, stroke and death. Improvements in Computed Tomography Cardiac Angiography (CTCA) technology have ensured its emergence as a useful clinical tool in CABG assessment, allowing for its potential use in planning interventional procedures in this patient group. Methods The BYPASS-CTCA study is a prospective, single centre, randomised controlled trial assessing the value of upfront CTCA in patients with previous surgical revascularisation undergoing ICA procedures. A total of 688 patients with previous CABG, requiring ICA for standard indications, will be recruited and randomised to receive ICA alone, or CTCA prior to angiography. Subjects will be followed up over a 12-month period post procedure. The primary endpoints are ICA procedural duration, incidence of contrast-induced nephropathy (CIN) and patient satisfaction scores post ICA. Secondary endpoints include contrast dose (mL) and radiation dose (mSv) during ICA, number of catheters used, angiography-related complications and cost-effectiveness of CTCA (QALY) over 12 months. Discussion The study will investigate the hypothesis that CTCA prior to ICA in patients with previous CABG can reduce procedural duration, post-procedural kidney damage and improve patient satisfaction, therefore strengthening its role in this group of patients. Trial Registration The study is registered on ClinicalTrials.gov which is a resource maintained by the U.S. National Library of Medicine. Registration number NCT03736018.
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Affiliation(s)
- Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Krishnaraj S Rathod
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Emily Castle
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Mervyn Andiapen
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Amy Richards
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anna Bellin
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Victoria Hammond
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Thomas Godec
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - James C Moon
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Ceri Davies
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Christos V Bourantas
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Francesca Pugliese
- NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel A Jones
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, UK
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28
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Rathod KS, Jones DA, Jain AK, Lim P, MacCarthy PA, Rakhit R, Lockie T, Kalra S, Dalby MC, Malik IS, Whitbread M, Firoozi S, Bogle R, Redwood S, Cooper J, Gupta A, Lansky A, Wragg A, Mathur A, Ahluwalia A. The influence of biological age and sex on long-term outcome after percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiovasc Dis 2021; 11:659-678. [PMID: 34849299 PMCID: PMC8611266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Outcome following ST-segment elevation myocardial infarction (STEMI) is thought to be worse in women than in age-matched men. We assessed whether such differences occur in the UK Pan-London dataset and if age, and particularly menopause, influences upon outcome. METHODS We undertook an observational cohort study of 26,799 STEMI patients (20,633 men, 6,166 women) between 2005-2015 at 8 centres across London, UK. Patient details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (IQR: 2.2-5.8 years). RESULTS Kaplan-Meier analysis demonstrated a higher mortality rate in women versus men (15.6% men vs. 25.3% women, P<0.0001). Univariate Cox analysis revealed that female sex was a predictor of all-cause mortality (HR: 1.69 95% CI: 1.59-1.82). However, after multivariate adjustment, this effect of female sex diminished (HR: 1.05 95% CI: 0.90-1.25). In a sub-group analysis, we compared the sexes separated by age into the ≤55 and the >55 year olds. Age-stratified Cox analysis revealed that female sex was a univariate predictor of all-cause mortality (HR: 1.60 95% CI: 1.25-2.05) in the ≤55 group and in the >55 group (HR: 1.38 95% CI: 1.28-1.47). However, after regression adjustment incorporating the propensity score into a proportional hazard model as a covariate, whilst female sex was not a significant predictor of all-cause mortality in the ≤55 group it was a predictor in the >55 group. Moreover, whilst age did not influence outcome in <55 group, this effect in the >55 group was correlated with age. CONCLUSIONS Overall women have a worse all-cause mortality following primary PCI for STEMI compared to men. However, this effect was driven predominantly by women >55 years of age since after adjusting for co-morbidities the risk in younger women did not differ significantly from that in men. These observations support the view that as women advance past the menopausal years their risk of further events following revascularization increases substantially and we suggest that routine assessment of hormonal status may improve clinical decision-making and ultimately outcome for women post-PCI.
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Affiliation(s)
- Krishnaraj S Rathod
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Daniel A Jones
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Ajay K Jain
- Barts Health NHS TrustLondon, United Kingdom
| | - Pitt Lim
- St. George’s Healthcare NHS Foundation Trust, St. George’s HospitalLondon, United Kingdom
| | - Philip A MacCarthy
- Kings College Hospital, King’s College Hospital NHS Foundation TrustDenmark Hill, London, United Kingdom
| | - Roby Rakhit
- Royal Free London NHS Foundation TrustPond Street, London, United Kingdom
| | - Tim Lockie
- Royal Free London NHS Foundation TrustPond Street, London, United Kingdom
| | - Sundeep Kalra
- Royal Free London NHS Foundation TrustPond Street, London, United Kingdom
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield HospitalHill End Road, Middlesex, United Kingdom
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith HospitalDu Cane Road, London, United Kingdom
| | - Mark Whitbread
- London Ambulance Service NHS TrustLondon, United Kingdom
| | - Sam Firoozi
- St. George’s Healthcare NHS Foundation Trust, St. George’s HospitalLondon, United Kingdom
| | - Richard Bogle
- St. George’s Healthcare NHS Foundation Trust, St. George’s HospitalLondon, United Kingdom
| | - Simon Redwood
- St. Thomas’ NHS Foundation Trust, Guys & St. Thomas HospitalWestminster Bridge Rd, London, United Kingdom
| | - Jackie Cooper
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Ajay Gupta
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Alexandra Lansky
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
- Section of Cardiology, Yale University School of MedicineNew Haven CT, USA
| | | | - Anthony Mathur
- Barts Health NHS TrustLondon, United Kingdom
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
| | - Amrita Ahluwalia
- William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of LondonLondon, United Kingdom
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Frain K, Rathod KS, Tumi E, Chen Y, Hamshere S, Choudry F, Akhtar MM, Curtis M, Amersey R, Guttmann O, O’Mahony C, Jain A, Wragg A, Baumbach A, Mathur A, Jones DA, Rees P. The impact of the COVID-19 pandemic on the delivery of primary percutaneous coronary intervention in STEMI. Am J Cardiovasc Dis 2021; 11:647-658. [PMID: 34849298 PMCID: PMC8611259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The clinical environment has been forced to adapt to meet the unprecedented challenges posed by the COVID-19 pandemic. Intensive care facilities were expanded in anticipation of the pandemic where the consequences include severe delays in elective procedures. Emergent procedures such as Percutaneous Coronary Intervention (PCI) in acute myocardial infarction (AMI) in which delays in timely delivery have well established adverse prognostic effects must also be explored in the context of changes in procedure and public behaviour associated with the COVID-19 pandemic. The aim for this single centre retrospective cohort study is to determine if door-to-balloon (D2B) times in PCI for ST Elevation Myocardial Infarction (STEMI) during the United Kingdom's first wave of the COVID-19 pandemic differed from pre-COVID-19 populations. METHODS Data was extracted from our single centre PCI database for all patients that underwent pPCI for STEMI. The reference (Pre-COVID-19) cohort was collected over the period 01-03-2019 to 31-05-2019 and the exposure group (COVID-19) over the period 01-03-2020 to 31-05-2020. Baseline patient characteristics for both populations were extracted. The primary outcome measurement was D2B times. Secondary outcome measurements included: time of symptom onset to call for help, transfer time to first hospital, transfer time from non-PCI to PCI centre, time from call-to-help to PCI centre, time to table and onset of symptoms to balloon time. Categorical and continuous variables were assessed with Chi squared and Mann-Whitney U analysis respectively. Procedural times were calculated and compared in the context of heterogeneity findings. RESULTS 4 baseline patient characteristics were unbalanced between populations with statistical significance (P<0.05). The pre-covid-19 cohort was more likely to have suffered out of hospital cardiac arrest (OHCA) and had left circumflex disease, whereas the 1st wave cohort were more likely to have been investigated with left ventriculography and be of Afro-Caribbean origin. No statistically significant difference in in-hospital procedural times was found with D2B, C2B, O2B times comparable between groups. Pre-hospital delays were the greatest contributors in missed target times: the 1st wave group had significantly longer delayed time of symptom onset to call for help (Control: 31 mins; IQR [82.5] vs 1st wave: 60 mins; IQR [90.0], P=0.001) and time taken from call for help to arrival at the PCI hospital (control: 72 mins; IQR [23] vs 1st wave: 80 mins; IQR [66.5], P=0.042). CONCLUSION Enhanced infection prevention and control procedures considering the COVID-19 pandemic did not impede the delivery of pPCI in our single centre cohort. The public health impact of the pandemic has been demonstrated with times being significantly impacted by patient related delays. The recovery of public engagement in emergency medical services must become the focus for public health initiatives as we emerge from the height of COVID-19 disease burden in the UK.
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Affiliation(s)
- Kristina Frain
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondon E1 4NS, UK
| | - Krishnaraj S Rathod
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Ebrahiem Tumi
- London School of Hygiene and Tropical MedicineLondon WC1E 7HT, UK
| | - Yang Chen
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Stephen Hamshere
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Fizzah Choudry
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Mohammed M Akhtar
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Miles Curtis
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Rajiv Amersey
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Oliver Guttmann
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Constantinos O’Mahony
- Faculty of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondon E1 4NS, UK
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
| | - Ajay Jain
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Andrew Wragg
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Andreas Baumbach
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Anthony Mathur
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Daniel A Jones
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
| | - Paul Rees
- St Bartholomew’s Hospital, Barts Health NHS TrustLondon EC1A 7BE, UK
- Centre for Cardiovascular Medicines and Devices, Queen Mary University LondonLondon E1 4NS, UK
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Verhemel S, Jones DA, Weeraman D, Veerapen J, Baumbach A, Mathur A. The impact of non-pharmacological therapies on cardiovascular outcomes in patients with refractory angina: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Despite advances in revascularization techniques and optimal medical management, refractory angina (RFA) represents an essential group of patients where progress has stalled, and in which therapeutic approaches remain uncertain.
Numerous randomized control trials have reported clinical outcomes on a variety of treatments but to date no direct outcome comparison has been made. Our aim is to investigate and compare the outcomes of these different non-pharmacological technologies in RFA, centring on major adverse cardiac events and all-cause mortality.
We performed a systematic review and meta-analysis of randomized controlled trials using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive search was performed of PubMed, EMBASE (Excerpta Medica database),Cochrane, ClinicalTrials.gov, Google Scholar databases of randomized controlled trials, and scientific session abstracts. Studies were deemed eligible if they met the following criteria: (1) full-length publications in peer-reviewed journals; (2) evaluated non-pharmacological therapies use in patients with no further revascularization options while on optimal medical treatment; (3) patients had ongoing angina, Canadian Cardiovascular Society class II–IV; and (4) included a placebo/control arm. We calculated risk ratios for all-cause mortality, combined MACE events. We assessed heterogeneity using χ2 and I2 tests.
We analysed 3292 citations with 51 randomized control trials testing 9 therapies including angiogenic proteins, stem-cell therapy, lipoprotein apheresis, coronary sinus reducer, spinal cord stimulator, percutaneous laser revascularization, shock-wave therapy, transmyocardial laser revascularization and enhanced external counter pulsation all meeting the inclusion criteria (table 1). Our analysis identified stem cell therapy as the only therapy with a reduction in all-cause mortality (Odds ratio, 0.45; CI, 0.21–1.00) (figure 1). A corresponding reduction in major adverse cardiac events (MACE) was also seen with stem cell therapy (OR 0.48: CI 0.30–0.75) alongside patients who received angiogenic proteins (OR 0.72: CI 0.55–0.93) and cardiac shockwave therapy (OR, 0.21: CI 0.10–0.46) Improvements in secondary measures of angina symptoms or frequency were seen with stem cell therapy, angiogenic proteins, coronary sinus reducer, spinal cord stimulator, shock-wave therapy, transmyocardial laser revascularization and enhanced external counterpulsation.
This is the largest meta-analysis comparing outcomes of novel technologies used in refractory angina. This suggests that stem cell therapy is the only non-pharmacological therapy for RFA associated with a reduction in mortality, MACE and anginal symptoms. We propose further larger randomized control trials, to support these findings.
Funding Acknowledgement
Type of funding sources: None. Table 1. Randomized control trials and outcomesFigure 1. All-cause mortality forest plot
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Affiliation(s)
- S Verhemel
- Barts Heart Centre, Department of Interventional Cardiology, London, United Kingdom
| | - D A Jones
- Barts Heart Centre, Department of Interventional Cardiology, London, United Kingdom
| | - D Weeraman
- Barts Heart Centre, Department of Interventional Cardiology, London, United Kingdom
| | - J Veerapen
- Queen Mary University of London, Barts NIHR Biomedical Research Centre, London, United Kingdom
| | - A Baumbach
- Barts Heart Centre, Department of Interventional Cardiology, London, United Kingdom
| | - A Mathur
- Barts Heart Centre, Department of Interventional Cardiology, London, United Kingdom
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31
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Patel KP, Michail M, Treibel TA, Rathod K, Jones DA, Ozkor M, Kennon S, Forrest JK, Mathur A, Mullen MJ, Lansky A, Baumbach A. Coronary Revascularization in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis. JACC Cardiovasc Interv 2021; 14:2083-2096. [PMID: 34620388 DOI: 10.1016/j.jcin.2021.07.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023]
Abstract
Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, with up to two thirds of patients with AS having significant CAD. Given the challenges when both disease states are present, these patients require a tailored approach diagnostically and therapeutically. In this review the authors address the impact of AS and aortic valve replacement (AVR) on coronary hemodynamic status and discuss the assessment of CAD and the role of revascularization in patients with concomitant AS and CAD. Remodeling in AS increases the susceptibility of myocardial ischemia, which can be compounded by concomitant CAD. AVR can improve coronary hemodynamic status and reduce ischemia. Assessment of the significance of coexisting CAD can be done using noninvasive and invasive metrics. Revascularization in patients undergoing AVR can benefit certain patients in whom CAD is either prognostically or symptomatically important. Identifying this cohort of patients is challenging and as yet incomplete. Patients with dual pathology present a diagnostic and therapeutic challenge; both AS and CAD affect coronary hemodynamic status, they provoke similar symptoms, and their respective treatments can have an impact on both diseases. Decisions regarding coronary revascularization should be based on understanding this complex relationship, using appropriate coronary assessment and consensus within a multidisciplinary team.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Michael Michail
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Krishnaraj Rathod
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Daniel A Jones
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mick Ozkor
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anthony Mathur
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Michael J Mullen
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Alexandra Lansky
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andreas Baumbach
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Yale University School of Medicine, New Haven, Connecticut, USA.
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Beirne AM, Mitchelmore O, Palma S, Andiapen M, Rathod KS, Hammond V, Bellin A, Cooper J, Wright P, Antoniou S, Yaqoob MM, Naci H, Mathur A, Ahluwalia A, Jones DA. NITRATE-CIN Study: Protocol of a Randomized (1:1) Single-Center, UK, Double-Blind Placebo-Controlled Trial Testing the Effect of Inorganic Nitrate on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography for Acute Coronary Syndromes. J Cardiovasc Pharmacol Ther 2021; 26:303-309. [PMID: 33764198 PMCID: PMC8132002 DOI: 10.1177/1074248421000520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN), an acute kidney injury resulting from the administration of intravascular iodinated contrast media, is a significant cause of morbidity/mortality following coronary angiographic procedures in high-risk patients. Despite preventative measures intended to mitigate the risk of CIN, there remains a need for novel effective treatments. Evidence suggests that delivery of nitric oxide (NO) through chemical reduction of inorganic nitrate to NO may offer a novel therapeutic strategy to reduce CIN and thus preserve long term renal function. DESIGN The NITRATE-CIN trial is a single-center, randomized, double-blind placebo-controlled trial, which plans to recruit 640 patients presenting with acute coronary syndromes (ACS) who are at risk of CIN. Patients will be randomized to either inorganic nitrate therapy (capsules containing 12 mmol KNO3) or placebo capsules containing potassium chloride (KCl) daily for 5 days. The primary endpoint is development of CIN using the Kidney Disease Improving Global Outcomes (KDIGO) criteria. A key secondary endpoint is renal function over a 3-month follow-up period. Additional secondary endpoints include serum renal biomarkers (e.g. neutrophil gelatinase-associated lipocalin) at 6 h, 48 h and 3 months following administration of contrast. Cost-effectiveness of inorganic nitrate therapy will also be evaluated. SUMMARY This study is designed to investigate the hypothesis that inorganic nitrate treatment decreases the rate of CIN as part of semi-emergent coronary angiography for ACS. Inorganic nitrate is a simple and easy to administer intervention that may prove useful in prevention of CIN in at-risk patients undergoing coronary angiographic procedures.
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Affiliation(s)
- Anne-Marie Beirne
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Oliver Mitchelmore
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Susana Palma
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mervyn Andiapen
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Krishnaraj S. Rathod
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Victoria Hammond
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Anna Bellin
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Jackie Cooper
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, London, United Kingdom
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, London, United Kingdom
| | | | - Huseyin Naci
- Department of Health Policy, London School of Economics, London, United Kingdom
| | - Anthony Mathur
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Daniel A. Jones
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
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Jones J, Rathod KS, Wragg A, Jones DA. Delayed diagnosis of compartment syndrome after transradial PCI, leading to long term disability. Cardiovasc Revasc Med 2021; 40S:254-257. [PMID: 34187753 DOI: 10.1016/j.carrev.2021.06.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022]
Abstract
The transradial access approach is a well-established route for coronary angiography and percutaneous intervention, given its lower complication rate over the transfemoral route. However, complications are still apparent, some of which can lead to serious injury. We report a case of delayed diagnosis of localized compartment syndrome, caused by haematoma and pseudoaneurysm formation following a radial procedure which resulted in long term disability. We emphasize the importance of early recognition and diagnosis of compartment syndrome to avoid long term sequalae.
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Affiliation(s)
- Johanna Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 3rd Floor, King George V Building, West Smithfield, London, UK
| | - Krishnaraj S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 3rd Floor, King George V Building, West Smithfield, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Andrew Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 3rd Floor, King George V Building, West Smithfield, London, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 3rd Floor, King George V Building, West Smithfield, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK.
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Seraphim A, Knott KD, Beirne AM, Augusto JB, Menacho K, Artico J, Joy G, Hughes R, Bhuva AN, Torii R, Xue H, Treibel TA, Davies R, Moon JC, Jones DA, Kellman P, Manisty C. Use of quantitative cardiovascular magnetic resonance myocardial perfusion mapping for characterization of ischemia in patients with left internal mammary coronary artery bypass grafts. J Cardiovasc Magn Reson 2021; 23:82. [PMID: 34134696 PMCID: PMC8210347 DOI: 10.1186/s12968-021-00763-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantitative myocardial perfusion mapping using cardiovascular magnetic resonance (CMR) is validated for myocardial blood flow (MBF) estimation in native vessel coronary artery disease (CAD). Following coronary artery bypass graft (CABG) surgery, perfusion defects are often detected in territories supplied by the left internal mammary artery (LIMA) graft, but their interpretation and subsequent clinical management is variable. METHODS We assessed myocardial perfusion using quantitative CMR perfusion mapping in 38 patients with prior CABG surgery, all with angiographically-proven patent LIMA grafts to the left anterior descending coronary artery (LAD) and no prior infarction in the LAD territory. Factors potentially determining MBF in the LIMA-LAD myocardial territory, including the impact of delayed contrast arrival through the LIMA graft were evaluated. RESULTS Perfusion defects were reported on blinded visual analysis in the LIMA-LAD territory in 27 (71%) cases, despite LIMA graft patency and no LAD infarction. Native LAD chronic total occlusion (CTO) was a strong independent predictor of stress MBF (B = - 0.41, p = 0.014) and myocardial perfusion reserve (MPR) (B = - 0.56, p = 0.005), and was associated with reduced stress MBF in the basal (1.47 vs 2.07 ml/g/min; p = 0.002) but not the apical myocardial segments (1.52 vs 1.87 ml/g/min; p = 0.057). Extending the maximum arterial time delay incorporated in the quantitative perfusion algorithm, resulted only in a small increase (3.4%) of estimated stress MBF. CONCLUSIONS Perfusion defects are frequently detected in LIMA-LAD subtended territories post CABG despite LIMA patency. Although delayed contrast arrival through LIMA grafts causes a small underestimation of MBF, perfusion defects are likely to reflect true reductions in myocardial blood flow, largely due to proximal native LAD disease.
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Affiliation(s)
- Andreas Seraphim
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anne-Marie Beirne
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Joao B Augusto
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Katia Menacho
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Jessica Artico
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - George Joy
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rebecca Hughes
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Hui Xue
- DHHS, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rhodri Davies
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Daniel A Jones
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Peter Kellman
- DHHS, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK.
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.
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Chen Y, Rathod KS, Hamshere S, Choudry F, Akhtar MM, Curtis M, Amersey R, Guttmann O, O'Mahony C, Jain A, Wragg A, Baumbach A, Mathur A, Jones DA. COVID-19 and changes in activity and treatment of ST elevation MI from a UK cardiac centre. Int J Cardiol Heart Vasc 2021; 33:100736. [PMID: 33644297 PMCID: PMC7901371 DOI: 10.1016/j.ijcha.2021.100736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/23/2022]
Abstract
Background The international healthcare response to COVID-19 has been driven by epidemiological data related to case numbers and case fatality rate. Second order effects have been less well studied. This study aimed to characterise the changes in emergency activity of a high-volume cardiac catheterisation centre and to cautiously model any excess indirect morbidity and mortality. Method Retrospective cohort study of patients admitted with acute coronary syndrome fulfilling criteria for the heart attack centre (HAC) pathway at St. Bartholomew’s hospital, UK. Electronic data were collected for the study period March 16th – May 16th 2020 inclusive and stored on a dedicated research server. Standard governance procedures were observed in line with the British Cardiovascular Intervention Society audit. Results There was a 28% fall in the number of primary percutaneous coronary interventions (PCIs) for ST elevation myocardial infarction (STEMI) during the study period (111 vs. 154) and 36% fewer activations of the HAC pathway (312 vs. 485), compared to the same time period averaged across three preceding years. In the context of ‘missing STEMIs’, the excess harm attributable to COVID-19 could result in an absolute increase of 1.3% in mortality, 1.9% in nonfatal MI and 4.5% in recurrent ischemia. Conclusions The emergency activity of a high-volume PCI centre was significantly reduced for STEMI during the peak of the first wave of COVID-19. Our data can be used as an exemplar to help future modelling within cardiovascular workstreams to refine aggregate estimates of the impact of COVID-19 and inform targeted policy action.
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Affiliation(s)
- Yang Chen
- Institute of Cardiovascular Science, University College London, UK.,St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Krishnaraj S Rathod
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Stephen Hamshere
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Fizzah Choudry
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Mohammed M Akhtar
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Miles Curtis
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Rajiv Amersey
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Oliver Guttmann
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Constantinos O'Mahony
- Institute of Cardiovascular Science, University College London, UK.,St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ajay Jain
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Andrew Wragg
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Andreas Baumbach
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Anthony Mathur
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
| | - Daniel A Jones
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicines and Devices, Queen Mary University London, UK
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36
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Tufaro V, Safi H, Torii R, Koo BK, Kitslaar P, Ramasamy A, Mathur A, Jones DA, Bajaj R, Erdoğan E, Lansky A, Zhang J, Konstantinou K, Little CD, Rakhit R, Karamasis GV, Baumbach A, Bourantas CV. Wall shear stress estimated by 3D-QCA can predict cardiovascular events in lesions with borderline negative fractional flow reserve. Atherosclerosis 2021; 322:24-30. [PMID: 33706080 DOI: 10.1016/j.atherosclerosis.2021.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS There is some evidence of the implications of wall shear stress (WSS) derived from three-dimensional quantitative coronary angiography (3D-QCA) models in predicting adverse cardiovascular events. This study investigates the efficacy of 3D-QCA-derived WSS in detecting lesions with a borderline negative fractional flow reserve (FFR: 0.81-0.85) that progressed and caused events. METHODS In this retrospective cohort study, we identified 548 patients who had at least one lesion with an FFR 0.81-0.85 and complete follow-up data; 293 lesions (286 patients) with suitable angiographic characteristics were reconstructed using a dedicated 3D-QCA software and included in the analysis. In the reconstructed models blood flow simulation was performed and the value of 3D-QCA variables and WSS distribution in predicting events was examined. The primary endpoint of the study was the composite of cardiac death, target lesion related myocardial infarction or clinically indicated target lesion revascularization. RESULTS During a median follow-up of 49.4 months, 37 events were reported. Culprit lesions had a greater area stenosis [(AS), 66.1% (59.5-72.3) vs 54.8% (46.5-63.2), p<0.001], smaller minimum lumen area [(MLA), 1.66 mm2 (1.45-2.30) vs 2.10 mm2 (1.69-2.70), p=0.011] and higher maximum WSS [9.0 Pa (5.10-12.46) vs 5.0 Pa (3.37-7.54), p < 0.001] than those that remained quiescent. In multivariable analysis, AS [hazard ratio (HR): 1.06, 95% confidence interval (CI): 1.03-1.10, p=0.001] and maximum WSS (HR: 1.08, 95% CI: 1.02-1.14, p=0.012) were the only independent predictors of the primary endpoint. Lesions with an increased AS (≥58.6%) that were exposed to high WSS (≥7.69Pa) were more likely to progress and cause events (27.8%) than those with a low AS exposed to high WSS (7.4%) or those exposed to low WSS that had increased (12.8%) or low AS (2.7%, p<0.001). CONCLUSIONS This study for the first time highlights the potential value of 3D-QCA-derived WSS in detecting, among lesions with a borderline negative FFR, those that cause cardiovascular events.
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Affiliation(s)
- Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Hannah Safi
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, South Korea
| | - Pieter Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands; Medis Medical Imaging Systems Bv, Leiden, the Netherlands
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Emrah Erdoğan
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Department of Cardiology, Van Yüzüncü Yıl University, Van, Turkey
| | - Alexandra Lansky
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Yale University School of Medicine, New Haven, CT, USA
| | - Jinlong Zhang
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, South Korea
| | | | - Callum D Little
- Department of Cardiology, Royal Free London NHS Trust, London, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Trust, London, UK
| | | | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Yale University School of Medicine, New Haven, CT, USA
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
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Choudry FA, Rathod KS, Baumbach A, Mathur A, Jones DA. Reply: Pitfalls of Unfractionated Heparin Use During ST-Segment Elevation Myocardial Infarction in Patients With COVID-19 Infection. J Am Coll Cardiol 2021; 77:105-106. [PMID: 33413933 PMCID: PMC7834880 DOI: 10.1016/j.jacc.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022]
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Choudry FA, Mathur A, Jones DA. Editorial commentary: Understanding thrombosis in COVID-19 - A long way to go. Trends Cardiovasc Med 2020; 31:161-162. [PMID: 33383172 PMCID: PMC7837022 DOI: 10.1016/j.tcm.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Fizzah A Choudry
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom.
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Kelham M, Choudry FA, Hamshere S, Beirne AM, Rathod KS, Baumbach A, Ahluwalia A, Mathur A, Jones DA. Therapeutic Implications of COVID-19 for the Interventional Cardiologist. J Cardiovasc Pharmacol Ther 2020; 26:203-216. [PMID: 33331160 DOI: 10.1177/1074248420982736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although COVID-19 is viewed primarily as a respiratory disease, cardiovascular risk factors and disease are prevalent among infected patients and are associated with worse outcomes. In addition, among multiple extra-pulmonary manifestations, there has been an increasing recognition of specific cardiovascular complications of COVID-19. Despite this, in the initial stages of the pandemic there was evidence of a reduction in patients presenting to acute cardiovascular services. In this masterclass review, with the aid of 2 exemplar cases, we will focus on the important therapeutic implications of COVID-19 for interventional cardiologists. We summarize the existing evidence base regarding the varied cardiovascular presentations seen in COVID-19 positive patients and the prognostic importance and potential mechanisms of acute myocardial injury in this setting. Importantly, through the use of a systematic review of the literature, we focus our discussion on the observed higher rates of coronary thrombus burden in patients with COVID-19 and acute coronary syndromes.
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Affiliation(s)
- Matthew Kelham
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Fizzah A Choudry
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
| | - Stephen Hamshere
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Anne-Marie Beirne
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
| | - Amrita Ahluwalia
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, 560754Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, 4617Queen Mary University of London, London, United Kingdom
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40
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Perera D, Rathod KS, Guttmann O, Beirne AM, O’Mahony C, Weerackody R, Baumbach A, Mathur A, Wragg A, Jones DA. Routine aspiration thrombectomy is associated with increased stroke rates during primary percutaneous coronary intervention for myocardial infarction. Am J Cardiovasc Dis 2020; 10:548-556. [PMID: 33489457 PMCID: PMC7811915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent studies have suggested that the routine use of aspiration thrombectomy catheters during primary percutaneous coronary intervention (PCI) do not result in improved mortality and may be associated with an increased stroke rate. This study sought to investigate this hypothesis. METHODS This was an observational study analysing data from a prospective database of 6366 patients undergoing primary PCI between August 2003 and May 2015 at a UK cardiac centre. Patients' details were collected from the hospital electronic database. Primary outcome was thirty-day stroke rates. RESULTS 3989 (62.7%) patients underwent PCI alone and 2,377 (37.3%) patients underwent PCI with adjuctive thrombus aspiration. PCI alone group had an older demographic (63 (± 14) years vs 60.7 (± 14)), a lower proportion of male participants 75% vs 79% (P=0.001) and cardiovascular risk factors such as hypertension 22.4% vs 25.3% (P=0.007), hypercholesterolemia 18.5% vs 22.6% (P<0.0001) and a history of smoking 33.5% vs 44.3% (P<0.0001). Thrombus aspiration was associated with a higher 30-day stroke rate [16 (0.7%) vs 11 (0.3%) (HR 2.51; 95% CI 1.03-6.08, P 0.03). Multivariate analysis suggested that this increased risk of stroke was maintained following adjustment for confounders (HR: 1.86; 95% CI 1.02-4.38). There was 379 deaths of which 114 (4.8%) were in the thrombus aspiration cohort vs 265 (6.6%) in PCI only cohort over the follow-up period (60 months). This resulted in a significantly lower rate of all-cause-mortality HR 0.70 (95% CI 0.52-0.94; P 0.02). There was no statistically significant difference in observed myocardial infarction rates HR 0.76 (95% CI 0.47-1.23; P 0.27) and the rates of unscheduled revascularisations HR 0.70 (95% CI 0.43-1.13; P 0.14) between the two groups. CONCLUSIONS Our data series of STEMI patients, suggest that routine thrombus aspiration during primary PCI is associated with a significantly higher stroke, rate however, thrombus aspiration reduced mortality rate. This is consistent with current guidelines which don't recommend the routine use of thrombus aspiration for primary PCI. A possible mortality reduction in patients with high thrombus grades was seen which may warrant further study.
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Rathod KS, Jain AK, Firoozi S, Lim P, Boyle R, Nevett J, Dalby MC, Kalra S, Malik IS, Sirker A, Mathur A, Redwood S, MacCarthy PA, Wragg A, Jones DA. Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group. European Heart Journal. Acute Cardiovascular Care 2020; 9:948-957. [DOI: 10.1177/2048872619882340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and aims:
In patients with ST-segment elevation myocardial infarction (STEMI), mortality is directly related to time to reperfusion with guidelines recommending patients be delivered directly to centres for primary percutaneous coronary intervention (PCI). The aim of this study was to describe the impact of inter-hospital transfer on reperfusion time and to assess whether or not treatment delays influenced clinical outcomes in comparison with direct admission to a primary PCI centre in a large regional network.
Method and results:
We undertook an observational cohort study of patients with STEMI treated with primary PCI between 2005 and 2015 in London, UK. Patient details were recorded at the time of the procedure in databases using the British Cardiovascular Intervention Society PCI dataset. The primary end-point was all-cause mortality at a median of 4.1 years (interquartile range: 2.2–5.8 years). Secondary outcomes were in-hospital major adverse cardiac events. Of 25,315 patients, 17,560 (69.4%) were admitted directly to a primary PCI centre and 7755 (31.6%) were transferred from a non-primary PCI centre. Patients in the direct admission group were older and more likely to have left ventricular impairment compared with the inter-hospital transfer group. Median time from call for help to reperfusion in transferred patients was 52 minutes longer compared with patients admitted directly (p <0.001). However, call to first hospital admission was similar. Kaplan–Meier analysis demonstrated significantly lower mortality rates in patients who were transferred directed to a primary PCI centre compared with patients who were transferred from a non-PCI centre (17.4% direct vs. 18.7% transfer, p=0.017). Furthermore, after propensity matching, direct admission for primary PCI was still a predictor of all-cause mortality (hazard ratio: 0.89, 95% confidence interval: 0.64–0.95).
Conclusions:
In this large registry of over 25,000 STEMI patients treated by primary PCI survival was better in patients admitted directly to a cardiac centre versus patients transferred for primary PCI, most likely due to longer call to balloon times in patient transferred from other hospitals.
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Affiliation(s)
| | | | - Sam Firoozi
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Pitt Lim
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Richard Boyle
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, London, UK
| | - Jo Nevett
- London Ambulance Service NHS Trust, UK
| | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Sundeep Kalra
- Royal Free Hospital, Royal Free London Foundation Trust, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | | | | | - Simon Redwood
- St Thomas’ NHS Foundation Trust, Guys & St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- King’s College Hospital, King’s College Hospital NHS Foundation Trust, London, UK
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Tyler Z, Guttmann OP, Dhinoja M, Oro R, Savvatis K, Mohiddin S, Sekhri N, Lopes L, Patel V, Jones DA, Bourantas CV, Mathur A, Elliott PM, O'Mahony C. The Safety and Feasibility of Transitioning From Transfemoral to Transradial Access Left Ventricular Endomyocardial Biopsy. J Invasive Cardiol 2020; 32:E349-E354. [PMID: 33168780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Left ventricular endomyocardial biopsy (LVEMB) is commonly performed via the transfemoral route. Radial access may help reduce vascular access complications, but there are few data on the safety and feasibility of transradial LVEMB. OBJECTIVE Describe the safety and feasibility of transitioning from transfemoral to transradial access LVEMB. METHODS This is a single-center, prospective, observational cohort study. Fifty procedures in 49 patients were included, 25 (50%) via the femoral route and 25 (50%) via the radial route. RESULTS The cohort had a mean age of 47 ± 13 years and the most common indication for LVEMB was myocarditis. From June 2015 until September 2016, all procedures (n = 21) were performed via the femoral approach; thenceforth, there was a gradual transition to the radial approach. More tissue samples were obtained when the procedure was performed via the femoral approach (P<.01). The minimum sampling target of 3 specimens was not met in 4 patients (16%) via the radial approach and in 1 patient (4%) via the femoral approach. Complications occurred in 3/25 transradial procedures (12%; 2 cardiac perforations and 1 forearm hematoma) and 3/25 transfemoral procedures (12%; 1 cardiac perforation, 1 femoral artery pseudoaneurysm, and 1 ventricular fibrillation). Cardiac perforations via the transradial approach occurred during the early transition period. There were no deaths. CONCLUSIONS Transradial LVEMB is feasible, with a similar complication profile to femoral procedures, but associated with a smaller number of specimens. Transitioning from transfemoral to transradial procedures may initially be associated with a higher risk of complications and potentially a lower diagnostic yield.
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Ramasamy A, Bajaj R, Jones DA, Amersey R, Mathur A, Baumbach A, Bourantas CV, O'Mahony C. Iatrogenic catheter-induced ostial coronary artery dissections: Prevalence, management, and mortality from a cohort of 55,968 patients over 10 years. Catheter Cardiovasc Interv 2020; 98:649-655. [PMID: 33241605 PMCID: PMC8518823 DOI: 10.1002/ccd.29382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022]
Abstract
Objective We sought to describe the prevalence, management strategies and evaluate the prognosis of patients with iatrogenic catheter‐induced ostial coronary artery dissection (ICOCAD). Background ICOCAD is a rare but potentially devastating complication of cardiac catheterisation. The clinical manifestations of ICOCAD vary from asymptomatic angiographic findings to abrupt vessel closure leading to myocardial infarction and death. Methods 55,968 patients who underwent coronary angiography over a 10‐year period were screened for ICOCAD as defined by the National Heart, Lung, and Blood Institute. The management and all‐cause mortality were retrieved from local and national databases. Results The overall prevalence of ICOCAD was 0.09% (51/55,968 patients). Guide catheters accounted for 75% (n = 37) of cases. Half of the ICOCAD cases involved the right coronary artery while the remaining were related to left main stem (23/51; 45%) and left internal mammary artery (2/51; 4%). Two‐thirds of ICOCAD were high grade (type D, E, and F). The majority of cases were type F dissections (n = 18; 66%), of which two third occurred in females in their 60s. The majority of ICOCAD patients (42/51; 82%) were treated with percutaneous coronary intervention while the remaining underwent coronary artery bypass grafting (3/51; 6%) or managed conservatively (6/51; 12%). Three deaths occurred during the index admission while 48/51 patients (94.1%) were safely discharged without further mortality over a median follow‐up of 3.6 years. Conclusions ICOCAD is a rare but life‐threatening complication of coronary angiography. Timely recognition and prompt bailout PCI is a safe option for majority of patients with good clinical outcomes.
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Affiliation(s)
- Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Rajiv Amersey
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Constantinos O'Mahony
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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Kelham M, Jones TN, Rathod KS, Guttmann O, Proudfoot A, Rees P, Knight CJ, Ozkor M, Wragg A, Jain A, Baumbach A, Mathur A, Jones DA. An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA). Eur Heart J Acute Cardiovasc Care 2020; 9:S67-S73. [PMID: 33241716 DOI: 10.1177/2048872620974606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume. METHODS We retrospectively analysed the data of OHCA patients pre- and post-merger. Baseline demographic and medical characteristics were recorded, along with factors relating to the cardiac arrest. The primary endpoint was in-hospital mortality. RESULTS OHCA patients (N =728; 267 pre- and 461 post-merger) between 2013 and 2018 were analysed. Patients admitted pre-merger were older (65.0 vs. 62.4 years, p=0.027), otherwise there were similar baseline demographic and peri-arrest characteristics. There was a greater proportion of non-acute coronary syndrome-related OHCA admission post-merger (10.1% vs. 23.4%, p=0.0001) and a corresponding decrease in those admitted with ST-elevation myocardial infarction (80.2% vs. 57.0%, p=0.0001) and those treated with percutaneous coronary intervention (78.8% vs. 54.0%, p=0.0001). Despite this, in-hospital mortality was lower post-merger (63.7% vs. 44.3%, p=0.0001), which persisted after adjustment for demographic and arrest-related characteristics using stepwise logistic regression (p=0.036) between the groups. CONCLUSION Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.
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Affiliation(s)
- Matthew Kelham
- Barts Interventional Group, Barts Heart Centre, London, UK
| | | | - Krishnaraj S Rathod
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Oliver Guttmann
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | | | - Paul Rees
- Barts Interventional Group, Barts Heart Centre, London, UK
| | | | - Muhiddin Ozkor
- Barts Interventional Group, Barts Heart Centre, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Ajay Jain
- Barts Interventional Group, Barts Heart Centre, London, UK
| | - Andreas Baumbach
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Anthony Mathur
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Daniel A Jones
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
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Rathod KS, Spagnolo M, Elliott MK, Beirne AM, Smith EJ, Amersey R, Knight C, Weerackody R, Baumbach A, Mathur A, Jones DA. An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention. Clin Med Insights Cardiol 2020; 14:1179546820951792. [PMID: 32913394 PMCID: PMC7444144 DOI: 10.1177/1179546820951792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022]
Abstract
Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality). 834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts (P = .62), which persisted after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]). Furthermore, in propensity-matched analysis there was no significant difference in outcome between the groups (HR: 0.86 95% CI: 0.75-1.25). Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital.
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Affiliation(s)
- Krishnaraj Sinhji Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Marco Spagnolo
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Mark K Elliott
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Anne-Marie Beirne
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Elliot J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Rajiv Amersey
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Charles Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Roshan Weerackody
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Andreas Baumbach
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
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McBeath KCC, Rathod KS, Cadd M, Beirne A, Guttmann O, Knight CJ, Amersey R, Bourantas CV, Wragg A, Smith EJ, Baumbach A, Mathur A, Jones DA. Use of enhanced stent visualisation compared to angiography alone to guide percutaneous coronary intervention. Int J Cardiol 2020; 321:24-29. [PMID: 32800911 DOI: 10.1016/j.ijcard.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We aimed to assess the use of enhanced stent visualisation (ESV) on outcomes, after PCI with overlapping stents, specifically using CLEARstent technology. BACKGROUND Stent underexpansion and overlap are both significant risk factors for restenosis and stent thrombosis. Enhanced stent visualisation (e.g. CLEARstent) systems could provide important data to reduce under-expansion and stent overlap. METHODS This was a cohort study based on this institution's percutaneous coronary intervention (PCI) registry. A total of 2614 patients who had PCI for stable angina or acute coronary syndromes (ACS, excluding cardiogenic shock) with overlapping 2nd generation drug eluting stents (DES) in the same vessel between May 2015 and January 2018 were included in the analysis. Patients were divided into ESV (n = 1354) and no ESV guided intervention (n = 1260). The primary end-point was major adverse cardiovascular events (MACE: target vessel revascularisation, target vessel myocardial infarction and all-cause mortality) recorded at a median follow up of 2.4 years. RESULTS Groups were comparable for patient characteristics (age, diabetes mellitus, ACS presentation). A significant difference in MACE was observed between patients who underwent ESV-guided PCI (9.5%) compared with patients who underwent Standard PCI (14.4%, p = .018). This difference was mainly driven by reduced rates of target vessel revascularisation and recurrent myocardial infarction. Overall this difference persisted after multivariate Cox analysis (HR 0.86, 95% CI: 0.73-0.98) and propensity matching (HR = 0.88, 95% CI: 0.69-0.99). CONCLUSION We suggest that routine clinical use of ESV technology during PCI can be useful, and is associated with better medium-term angiographic and clinical outcomes. Further study is required to build on this promising signal.
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Affiliation(s)
- K C C McBeath
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - K S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - M Cadd
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - A Beirne
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - O Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - C J Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - R Amersey
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - C V Bourantas
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - A Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - E J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - A Baumbach
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - A Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - D A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom.
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Jones DA, Wright P, Alizadeh MA, Fhadil S, Rathod KS, Guttmann O, Knight C, Timmis A, Baumbach A, Wragg A, Mathur A, Antoniou S. The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction. European Heart Journal - Cardiovascular Pharmacotherapy 2020; 7:398-404. [PMID: 32730627 DOI: 10.1093/ehjcvp/pvaa096] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/08/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022]
Abstract
Abstract
Aim
Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3–6 months for treatment of left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority of novel oral anticoagulants (NOAC) compared to VKA for other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence for the treatment of LV thrombus post-AMI. In this study, we investigated the safety and effect of NOACs compared to VKA on LV thrombus resolution in patients presenting with AMI.
Methods and results
This was an observational study of 2328 consecutive patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) for AMI between May 2015 and December 2018, at a UK cardiac centre. Patients’ details were collected from the hospital electronic database. The primary endpoint was rate of LV thrombus resolution with bleeding rates a secondary outcome. Left ventricular thrombus was diagnosed in 101 (4.3%) patients. Sixty patients (59.4%) were started on VKA and 41 patients (40.6%) on NOAC therapy (rivaroxaban: 58.5%, apixaban: 36.5%, and edoxaban: 5.0%). Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (previous myocardial infarction, PCI, coronary artery bypass grafting), and cardiovascular risk factors (hypertension, diabetes, hypercholesterolaemia). Over the follow-up period (median 2.2 years), overall rates of LV thrombus resolution were 86.1%. There was greater and earlier LV thrombus resolution in the NOAC group compared to patients treated with warfarin (82% vs. 64.4%, P = 0.0018, at 1 year), which persisted after adjusting for baseline variables (odds ratio 1.8, 95% confidence interval 1.2–2.9). Major bleeding events during the follow-up period were lower in the NOAC group, compared with VKA group (0% vs. 6.7%, P = 0.030) with no difference in rates of systemic thromboembolism (5% vs. 2.4%, P = 0.388).
Conclusion
These data suggest improved thrombus resolution in post-acute coronary syndrome (ACS) LV thrombosis in patients treated with NOACs compared to VKAs. This improvement in thrombus resolution was accompanied with a better safety profile for NOAC patients vs. VKA-treated patients. Thus, provides data to support a randomized trial to answer this question.
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Affiliation(s)
- Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Paul Wright
- Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Momin A Alizadeh
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Sadeer Fhadil
- Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Oliver Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Charles Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Adam Timmis
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Andreas Baumbach
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Andrew Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
- Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, UK
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Choudry FA, Hamshere SM, Rathod KS, Akhtar MM, Archbold RA, Guttmann OP, Woldman S, Jain AK, Knight CJ, Baumbach A, Mathur A, Jones DA. High Thrombus Burden in Patients With COVID-19 Presenting With ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2020; 76:1168-1176. [PMID: 32679155 PMCID: PMC7833185 DOI: 10.1016/j.jacc.2020.07.022] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
Background Coronavirus disease-2019 (COVID-19) is thought to predispose patients to thrombotic disease. To date there are few reports of ST-segment elevation myocardial infarction (STEMI) caused by type 1 myocardial infarction in patients with COVID-19. Objectives The aim of this study was to describe the demographic, angiographic, and procedural characteristics alongside clinical outcomes of consecutive cases of COVID-19–positive patients with STEMI compared with COVID-19–negative patients. Methods This was a single-center, observational study of 115 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention at Barts Heart Centre between March 1, 2020, and May 20, 2020. Results Patients with STEMI presenting with concurrent COVID-19 infection had higher levels of troponin T and lower lymphocyte count, but elevated D-dimer and C-reactive protein. There were significantly higher rates of multivessel thrombosis, stent thrombosis, higher modified thrombus grade post first device with consequently higher use of glycoprotein IIb/IIIa inhibitors and thrombus aspiration. Myocardial blush grade and left ventricular function were significantly lower in patients with COVID-19 with STEMI. Higher doses of heparin to achieve therapeutic activated clotting times were also noted. Importantly, patients with STEMI presenting with COVID-19 infection had a longer in-patient admission and higher rates of intensive care admission. Conclusions In patients presenting with STEMI and concurrent COVID-19 infection, there is a strong signal toward higher thrombus burden and poorer outcomes. This supports the need for establishing COVID-19 status in all STEMI cases. Further work is required to understand the mechanism of increased thrombosis and the benefit of aggressive antithrombotic therapy in selected cases.
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Affiliation(s)
- Fizzah A Choudry
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Stephen M Hamshere
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mohammed M Akhtar
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - R Andrew Archbold
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Oliver P Guttmann
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Simon Woldman
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ajay K Jain
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Charles J Knight
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
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49
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Rathod KS, Beirne A, Bogle R, Firoozi S, Lim P, Hill J, Dalby MC, Jain AK, Malik IS, Mathur A, Kalra SS, DeSilva R, Redwood S, MacCarthy PA, Wragg A, Smith EJ, Jones DA. Prior Coronary Artery Bypass Graft Surgery and Outcome After Percutaneous Coronary Intervention: An Observational Study From the Pan-London Percutaneous Coronary Intervention Registry. J Am Heart Assoc 2020; 9:e014409. [PMID: 32475202 PMCID: PMC7429029 DOI: 10.1161/jaha.119.014409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Limited information exists regarding procedural success and clinical outcomes in patients with previous coronary artery bypass grafting (CABG) undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without CABG. Methods and Results This was an observational cohort study of 123 780 consecutive PCI procedures from the Pan‐London (UK) PCI registry from 2005 to 2015. The primary end point was all‐cause mortality at a median follow‐up of 3.0 years (interquartile range, 1.2–4.6 years). A total of 12 641(10.2%) patients had a history of previous CABG, of whom 29.3% (n=3703) underwent PCI to native vessels and 70.7% (n=8938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow‐up was significantly higher in patients with prior CABG (23.2%; P=0.0005) compared with patients with no prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%; P<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (hazard ratio [HR],1.02; 95%CI, 0.77–1.34; P=0.89), but a significantly higher mortality was seen among patients with PCI to bypass grafts (HR,1.33; 95% CI, 1.03–1.71; P=0.026). This was seen after multivariate adjustment and propensity matching. Conclusions Patients with prior CABG were older with greater comorbidities and more complex procedural characteristics, but after adjustment for these differences, the clinical outcomes were similar to the patients undergoing PCI without prior CABG. In these patients, native‐vessel PCI was associated with better outcomes compared with the treatment of vein grafts.
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Affiliation(s)
- Krishnaraj S. Rathod
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
| | - Anne‐Marie Beirne
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
- Imperial College Healthcare National Health Service Foundation TrustHammersmith HospitalLondonUnited Kingdom
| | - Richard Bogle
- St. George’s Healthcare National Health Service Foundation TrustSt. George’s HospitalLondonUnited Kingdom
| | - Sam Firoozi
- St. George’s Healthcare National Health Service Foundation TrustSt. George’s HospitalLondonUnited Kingdom
| | - Pitt Lim
- St. George’s Healthcare National Health Service Foundation TrustSt. George’s HospitalLondonUnited Kingdom
| | - Jonathan Hill
- Kings College HospitalKing’s College Hospital National Health Service Foundation TrustLondonUnited Kingdom
| | - Miles C. Dalby
- Royal Brompton & Harefield National Health Service Foundation TrustHarefield HospitalUxbridgeUnited Kingdom
| | - Ajay K. Jain
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
| | - Iqbal S. Malik
- Imperial College Healthcare National Health Service Foundation TrustHammersmith HospitalLondonUnited Kingdom
| | - Anthony Mathur
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
| | - Sundeep Singh Kalra
- Royal Free London National Health Service Foundation TrustLondonUnited Kingdom
| | - Ranil DeSilva
- Royal Brompton & Harefield National Health Service Foundation TrustHarefield HospitalUxbridgeUnited Kingdom
| | - Simon Redwood
- St Thomas’ National Health Service Foundation TrustGuys & St. Thomas HospitalLondonUnited Kingdom
| | - Philip A. MacCarthy
- Kings College HospitalKing’s College Hospital National Health Service Foundation TrustLondonUnited Kingdom
| | - Andrew Wragg
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
| | - Elliot J. Smith
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
| | - Daniel A. Jones
- Barts Heart CentreBarts Health National Health Service TrustLondonUnited Kingdom
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50
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Gupta AK, Jneid H, Addison D, Ardehali H, Boehme AK, Borgaonkar S, Boulestreau R, Clerkin K, Delarche N, DeVon HA, Grumbach IM, Gutierrez J, Jones DA, Kapil V, Maniero C, Mentias A, Miller PS, Ng SM, Parekh JD, Sanchez RH, Sawicki KT, te Riele ASJM, Remme CA, London B. Current Perspectives on Coronavirus Disease 2019 and Cardiovascular Disease: A White Paper by the JAHA Editors. J Am Heart Assoc 2020; 9:e017013. [PMID: 32347144 PMCID: PMC7429024 DOI: 10.1161/jaha.120.017013] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020. In this White Paper, we address the cardiovascular co-morbidities of COVID-19 infection; the diagnosis and treatment of standard cardiovascular conditions during the pandemic; and the diagnosis and treatment of the cardiovascular consequences of COVID-19 infection. In addition, we will also address various issues related to the safety of healthcare workers and the ethical issues related to patient care in this pandemic.
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Affiliation(s)
- Ajay K. Gupta
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Hani Jneid
- Division of CardiologyBaylor College of MedicineHoustonTX
| | - Daniel Addison
- Division of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Hossein Ardehali
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern UniversityChicagoIL
| | - Amelia K. Boehme
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNY
| | | | | | - Kevin Clerkin
- Division of CardiologyDepartment of MedicineVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | | | - Holli A. DeVon
- University of California, Los Angeles, School of NursingLos AngelesCA
| | - Isabella M. Grumbach
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
| | - Jose Gutierrez
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNY
| | - Daniel A. Jones
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Vikas Kapil
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
| | - Carmela Maniero
- William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonUnited Kingdom
- Barts BP Centre of ExcellenceBarts Heart CentreLondonUnited Kingdom
| | - Amgad Mentias
- Division of CardiologyDepartment of Internal MedicineUniversity of IowaIowa CityIA
| | | | - Sher May Ng
- Royal London and St Bartholomew’s HospitalBarts Health NHS TrustLondonUnited Kingdom
| | - Jai D. Parekh
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
| | - Reynaldo H. Sanchez
- Division of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Konrad Teodor Sawicki
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern UniversityChicagoIL
| | - Anneline S. J. M. te Riele
- Division of Heart and LungsDepartment of CardiologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental CardiologyHeart CentreAmsterdam UMCLocation Academic Medical CenterAmsterdamthe Netherlands
| | - Barry London
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of IowaCarver College of MedicineIowa CityIA
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