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Sardar P, Chatterjee S, Song Z. Private Equity and Cardiovascular Health Care. JAMA Cardiol 2024; 9:203-204. [PMID: 38198174 DOI: 10.1001/jamacardio.2023.5127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
This Viewpoint discusses involvement of private equity firms in health care.
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Affiliation(s)
- Partha Sardar
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York
- Columbia Business School, New York, New York
| | - Saurav Chatterjee
- Department of Cardiology, Maimonides Medical Center, New York, New York
| | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- Center for Primary Care, Harvard Medical School, Boston, Massachusetts
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Chatterjee S, Sharma A, Easly-Merski R, dastidar A, Aggarwal V, Abaza K, Sardar P. THREE FACTORS COMBINED PREDICT IN-HOSPITAL MORTALITY IN CARDIOGENIC SHOCK. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01693-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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3
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Csecs I, Abbott JD, Thachil R, Kundu A, Chatterjee S, Sardar P, Faillace RT. RELATIONSHIP WITH INDUSTRY AND OTHER ENTITIES IN CURRENT CARDIOVASCULAR CLINICAL PRACTICE GUIDELINES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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4
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Rizk JG, Gupta A, Lazo JG, Sardar P, Henry BM, Lavie CJ, Effron MB. To Anticoagulate or Not to Anticoagulate in COVID-19: Lessons after 2 Years. Semin Thromb Hemost 2023; 49:62-72. [PMID: 35468641 DOI: 10.1055/s-0042-1744302] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been well documented and is believed to be strongly supported by a proinflammatory state. The hypercoagulable state in turn results in increased incidence of arterial and venous thromboembolism (VTE) seen in hospitalized COVID-19 when compared with hospitalized non-COVID-19 patient cohorts. Moreover, patients with arterial or VTE and COVID-19 have higher mortality compared with COVID-19 patients without arterial or VTE. Prevention of arterial or VTE thus remains an essential question in the management of COVID-19 patients, especially because of high rates of reported microvascular and macrovascular thrombosis. This has prompted multiple randomized control trials (RCTs) evaluating different anticoagulation strategies in COVID-19 patients at various stages of the disease. Herein, we review findings from RCTs in the past 2 years of antithrombotic therapy in critically ill hospitalized patients, noncritically ill hospitalized patients, patients postdischarge from the hospital, and outpatients. RCTs in critically ill patients demonstrated therapeutic dose anticoagulation does not improve outcomes and has more bleeding than prophylaxis dose anticoagulant in these patients. Trials in noncritically ill hospitalized patients showed a therapeutic dose anticoagulation with a heparin formulation might improve clinical outcomes. Anticoagulation with a direct oral anticoagulant posthospital discharge may improve outcomes, although there is a large RCT in progress. Nonhospitalized COVID-19 patients have an insufficient burden of events to be candidates for antithrombotic therapy. Anticoagulation in pregnant and lactating patients with COVID-19, as well as antiplatelet therapy for COVID-19, is also reviewed.
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Affiliation(s)
- John G Rizk
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Aashish Gupta
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Jose G Lazo
- UCSF Medical Center, University of California, San Francisco, San Francisco, California
| | - Partha Sardar
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Disease Prevention and Intervention & Population Health Programs, Texas Biomedical Research Institute, San Antonio, Texas
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
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Upadhyaya V, Gowda SN, Porto G, Bavishi CP, Sardar P, Bashir R, Gokceer ME, Chatterjee S. Does the ISCHEMIA Trial Apply to My Patients? Curr Cardiol Rep 2022; 24:653-657. [PMID: 35353329 DOI: 10.1007/s11886-022-01684-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The ISCHEMIA trial demonstrated no difference in myocardial infarction or death in patients with stable coronary disease and moderate or large ischemia territory treated either with invasive revascularization or optimal medical therapy. Whether the findings of the randomized control trial relates to real-world outcomes is uncertain. RECENT FINDINGS Contemporary guideline-directed medical therapy has had a significant impact on the prognosis of coronary artery disease. Various observational data appear to indicate limited generalizability of the ISCHEMIA trial in different populations. Further studies are warranted to evaluate the optimal modality of therapy in patients with stable coronary disease and moderate or severe ischemia. The applicability of ISCHEMIA and ISCHEMIA-CKD trials still requires further validation.
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Affiliation(s)
- Vandan Upadhyaya
- Division of Cardiology, Jersey Shore Medical Center, Neptune, NJ, USA
| | | | - Gustavo Porto
- Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Chirag P Bavishi
- Division of Cardiology, University of Missouri Columbia, Columbia, MO, USA
| | - Partha Sardar
- Division of Cardiology, Ochsner Clinic, New Orleans, LA, USA
| | - Riyaz Bashir
- Division of Cardiology, Temple University Hospitals, Philadelphia, PA, USA
| | | | - Saurav Chatterjee
- Division of Cardiovascular Medicine, Long Island Jewish Medical Center, 270-05 76th Street, New Hyde Park, NY, 11040, USA.
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Tripathi B, Aggarwal V, Abbott JD, Kumbhani DJ, Giri J, Kalra A, Sardar P, Chatterjee S. Mechanical Complications in ST-Elevation Myocardial Infarction (STEMI) Based on Different Reperfusion Strategies. Am J Cardiol 2021; 156:79-84. [PMID: 34311972 DOI: 10.1016/j.amjcard.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
Contemporary trends of mechanical complications like papillary muscle rupture (PMR), ventricular septal defect/rupture (VSR), and free wall rupture (FWR) in ST-elevation m'yocardial infarction (STEMI), especially in the era of primary percutaneous coronary interventions (PPCI) has not been definitively investigated. We utilized the National Inpatient Sample (NIS) database from years 2003 to 2017 using International Classification of Disease 9th and 10th revision (ICD-9 and ICD-10) codes to identify STEMI patients undergoing PPCI, fibrinolysis alone, and fibrinolysis with subsequent PCI. We identified those developing in-hospital PMR /VSD / FWR. We identified a total of 2,034,153 STEMI patients where 93.5% had PPCI, 3.2% had fibrinolysis alone, and 3.3% had fibrinolysis with subsequent PCI. Rates of all mechanical complications was low for all three different reperfusion strategies evaluated, with downward trends (p <0.05) over time. No statistically significant difference in the rates of mechanical complication was noted among patients treated with different reperfusion strategies on multivariable logistic regression models. In conclusion, in a contemporary cohort of US patients-majority of whom were managed with PPCI, the rates of overall mechanical complications after STEMI were low even with initial use of fibrinolytics and exhibited a downward temporal trend.
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Affiliation(s)
- Byomesh Tripathi
- Division of Cardiovascular Medicine, University of Arizona, Phoenix, Arizona
| | - Vikas Aggarwal
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jinnette Dawn Abbott
- Division of Cardiology, Lifespan Cardiovascular Institute, Brown University and Rhode Island Hospitals, Providence, Rhode Island
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Jay Giri
- Division of Cardiovascular Medicine, Perelman School of Medicine, Philadelphia and The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Regional Section of Interventional Cardiology at Cleveland Clinic Akron General, College of Medicine of Case Western Reserve University
| | - Partha Sardar
- Division of Cardiology, Ochsner Clinic, New Orleans, Louisiana
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore-Long Island Jewish Medical Centers, Northwell Health, Zucker School of Medicine New York, New York.
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Rizk JG, Gupta A, Sardar P, Henry BM, Lewin JC, Lippi G, Lavie CJ. Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis: A Review. JAMA Cardiol 2021; 6:1451-1460. [PMID: 34374713 DOI: 10.1001/jamacardio.2021.3444] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [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: 12/29/2022]
Abstract
Importance The COVID-19 pandemic saw one of the fastest developments of vaccines in an effort to combat an out-of-control pandemic. The 2 most common COVID-19 vaccine platforms currently in use, messenger RNA (mRNA) and adenovirus vector, were developed on the basis of previous research in use of this technology. Postauthorization surveillance of COVID-19 vaccines has identified safety signals, including unusual cases of thrombocytopenia with thrombosis reported in recipients of adenoviral vector vaccines. One of the devastating manifestations of this syndrome, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), is cerebral venous sinus thrombosis (CVST). This review summarizes the current evidence and indications regarding biology, clinical characteristics, and pharmacological management of VITT with CVST. Observations VITT appears to be similar to heparin-induced thrombocytopenia (HIT), with both disorders associated with thrombocytopenia, thrombosis, and presence of autoantibodies to platelet factor 4 (PF4). Unlike VITT, HIT is triggered by recent exposure to heparin. Owing to similarities between these 2 conditions and lack of high-quality evidence, interim recommendations suggest avoiding heparin and heparin analogues in patients with VITT. Based on initial reports, female sex and age younger than 60 years were identified as possible risk factors for VITT. Treatment consists of therapeutic anticoagulation with nonheparin anticoagulants and prevention of formation of autoantibody-PF4 complexes, the latter being achieved by administration of high-dose intravenous immunoglobin (IVIG). Steroids, which can theoretically inhibit the production of new antibodies, have been used in combination with IVIG. In severe cases, plasma exchange should be used for clearing autoantibodies. Monoclonal antibodies, such as rituximab and eculizumab, can be considered when other therapies fail. Routine platelet transfusions, aspirin, and warfarin should be avoided because of the possibility of worsening thrombosis and magnifying bleeding risk. Conclusions and Relevance Adverse events like VITT, while uncommon, have been described despite vaccination remaining the most essential component in the fight against the COVID-19 pandemic. While it seems logical to consider the use of types of vaccines (eg, mRNA-based administration) in individuals at high risk, treatment should consist of therapeutic anticoagulation mostly with nonheparin products and IVIG.
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Affiliation(s)
- John G Rizk
- Arizona State University, Edson College, Phoenix, Arizona
| | - Aashish Gupta
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Partha Sardar
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Brandon Michael Henry
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John C Lewin
- National Coalition on Health Care, Washington, DC
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
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Abstract
Chronic mesenteric ischemia (CMI) is an uncommon, potentially underdiagnosed clinical condition. Although there is a high prevalence of mesenteric artery stenoses (MAS), an abundant collateral network in the mesenteric circulation mitigates occurrence of ischemia. The most common etiology of CMI is atherosclerosis. CMI is a clinical diagnosis, based upon typical and atypical symptoms and consistent anatomic findings. Typical symptoms of CMI are postprandial abdominal pain, unintended weight loss and food avoidance. The main modalities to diagnose MAS are duplex ultrasound, CT angiography or MR angiography, although high resolution CTA is preferred. Endovascular therapy with balloon expandable stents has become the preferred treatment for MAS.
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Affiliation(s)
- Partha Sardar
- Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, The Ochsner Clinical School, University of Queensland, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America
| | - Christopher J White
- Department of Cardiovascular Diseases, The John Ochsner Heart and Vascular Institute, The Ochsner Clinical School, University of Queensland, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, United States of America.
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Elbadawi A, Elgendy IY, Sardar P, Omer MA, Ogunbayo G, Bhatt DL. Palliative Care Utilization Among Patients With Critical Limb Ischemia: Insights From a National Database. JACC Cardiovasc Interv 2021; 13:1729-1731. [PMID: 32703603 DOI: 10.1016/j.jcin.2020.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
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Sardar P, Abbott JD, Kundu A, Aronow HD, Granada JF, Giri J. Impact of Artificial Intelligence on Interventional Cardiology: From Decision-Making Aid to Advanced Interventional Procedure Assistance. JACC Cardiovasc Interv 2020; 12:1293-1303. [PMID: 31320024 DOI: 10.1016/j.jcin.2019.04.048] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 08/08/2018] [Revised: 02/26/2019] [Accepted: 04/02/2019] [Indexed: 11/26/2022]
Abstract
Access to big data analyzed by supercomputers using advanced mathematical algorithms (i.e., deep machine learning) has allowed for enhancement of cognitive output (i.e., visual imaging interpretation) to previously unseen levels and promises to fundamentally change the practice of medicine. This field, known as "artificial intelligence" (AI), is making significant progress in areas such as automated clinical decision making, medical imaging analysis, and interventional procedures, and has the potential to dramatically influence the practice of interventional cardiology. The unique nature of interventional cardiology makes it an ideal target for the development of AI-based technologies designed to improve real-time clinical decision making, streamline workflow in the catheterization laboratory, and standardize catheter-based procedures through advanced robotics. This review provides an introduction to AI by highlighting its scope, potential applications, and limitations in interventional cardiology.
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Affiliation(s)
- Partha Sardar
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Amartya Kundu
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Juan F Granada
- Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania.
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Tripathi B, Kumbhani DJ, Giri J, Sardar P, Chatterjee S. Current trends in utilization of fibrinolytic‐based reperfusion strategies and bleeding outcomes in
ST
‐elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 96:E566-E567. [DOI: 10.1002/ccd.29094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Byomesh Tripathi
- Division of Cardiovascular Medicine University of Arizona Phoenix Arizona USA
| | - Dharam J. Kumbhani
- Division of Cardiology University of Texas Southwestern School of Medicine Dallas Texas USA
| | - Jay Giri
- Division of Cardiovascular Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia and The Leonard Davis Institute of Health Economics, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Partha Sardar
- Division of Cardiology Massachusetts General Hospital Boston Massachusetts USA
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore‐Long Island Jewish Medical Centers Northwell Health, and Assistant Professor, Zucker School of Medicine New York New York USA
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Aronow HD, Sardar P. Renal Sympathetic Denervation for Hypertension: Outside-In and Inside-Out. Cardiovasc Revasc Med 2020; 21:538-539. [PMID: 32563528 DOI: 10.1016/j.carrev.2020.03.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Herbert D Aronow
- Division of Cardiology, Warren Alpert Medical School at Brown University/Lifespan Cardiovascular Institute, Providence, RI, USA.
| | - Partha Sardar
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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Sardar P, Piazza G, Goldhaber SZ, Liu PY, Prabhu W, Soukas P, Aronow HD. Predictors of Treatment Response Following Ultrasound-Facilitated Catheter-Directed Thrombolysis for Submassive and Massive Pulmonary Embolism. Circ Cardiovasc Interv 2020; 13:e008747. [DOI: 10.1161/circinterventions.119.008747] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Little is known about which factors predict improvement in clinical and imaging parameters among patients undergoing catheter-directed thrombolysis for submassive or massive pulmonary embolism. The identification of such predictors may allow for more appropriate patient selection for ultrasound-facilitated catheter-directed thrombolysis.
Methods:
We conducted a retrospective cohort analysis of patients from the SEATTLE II trial (Prospective, Single-Arm, Multi-Center Trial of EkoSonic Endovascular System and Activase for Treatment of Acute Pulmonary Embolism) to identify clinical characteristics that independently predict pulmonary artery pressures, right ventricular-to-left ventricular (RV/LV) diameter ratio, and modified Miller angiographic index following ultrasound-assisted catheter-directed thrombolysis. Eligible patients had submassive or massive pulmonary embolism and an RV/LV diameter ratio ≥0.9 on chest computed tomography. Multivariable linear regression was used to identify independent clinical predictors of each outcome.
Results:
One hundred fifty patients with massive (n=31) or submassive (n=119) pulmonary embolism were enrolled. Mean (±SD) baseline and postprocedure RV/LV diameter ratio, pulmonary artery systolic pressure, and modified Miller Score were 1.59 (±0.39) and 1.14 (±0.2), 51.45 (±16.0), and 37.47 (±11.9), and 23.0 (±5.7) and 15.7 (±5.9), respectively. The multivariable model adjusted
R
2
for absolute change in RV/LV ratio, pulmonary artery systolic pressure, modified Miller Score was 0.71, 0.57, and 0.43, respectively. After adjusting for age, gender, and baseline RV/LV ratio, pulmonary artery systolic pressure, and modified Miller Score, patients with higher body mass index, renal or hepatic dysfunction, active smoking, or a higher baseline heart rate showed less improvement.
Conclusions:
Patients with more life-threatening pulmonary embolism may derive the greatest benefit from ultrasound-assisted, catheter-directed thrombolysis.
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Affiliation(s)
- Partha Sardar
- Division of Cardiology, Massachusetts General Hospital, Boston (P. Sardar)
| | - Gregory Piazza
- Thrombosis Research Group, Vascular Medicine Section, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (G.P., S.Z.G)
| | - Samuel Z. Goldhaber
- Thrombosis Research Group, Vascular Medicine Section, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (G.P., S.Z.G)
| | - Ping-Yu Liu
- Fred Hutchinson Cancer Center, Seattle, WA (P.-Y.L.)
| | - William Prabhu
- Heart and Vascular Institute, Westchester Medical Center, Valhalla, NY (W.P.)
| | - Peter Soukas
- Warren Alpert Medical School at Brown University/Lifespan Cardiovascular Institute, Providence, RI (P. Soukas, H.D.A.)
| | - Herbert D. Aronow
- Warren Alpert Medical School at Brown University/Lifespan Cardiovascular Institute, Providence, RI (P. Soukas, H.D.A.)
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Kundu A, Sardar P, Chakrabarty S, Hassan A, Ogunsua A, Qureshi W. COMPARISON OF SHORT-TERM, MID-TERM AND LONG-TERM MORTALITY IN PATIENTS WITH UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE TREATED WITH DRUG-ELUTING STENTS VS. BYPASS SURGERY: INSIGHTS FROM AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sardar P, Bhatt DL, Kirtane AJ, Kennedy KF, Chatterjee S, Giri J, Soukas PA, White WB, Parikh SA, Aronow HD. Sham-Controlled Randomized Trials of Catheter-Based Renal Denervation in Patients With Hypertension. J Am Coll Cardiol 2020; 73:1633-1642. [PMID: 30947915 DOI: 10.1016/j.jacc.2018.12.082] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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] [Received: 09/03/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are conflicting data regarding the relative effectiveness of renal sympathetic denervation (RSD) in patients with hypertension. OBJECTIVES The purpose of this study was to evaluate the blood pressure (BP) response after RSD in sham-controlled randomized trials. METHODS Databases were searched through June 30, 2018. Randomized trials (RCTs) with ≥50 patients comparing catheter-based RSD with a sham control were included. The authors calculated summary treatment estimates as weighted mean differences (WMD) with 95% confidence intervals (CIs) using random-effects meta-analysis. RESULTS The analysis included 977 patients from 6 trials. The reduction in 24-h ambulatory systolic blood pressure (ASBP) was significantly greater for patients treated with RSD than sham procedure (WMD -3.65 mm Hg, 95% CI: -5.33 to -1.98; p < 0.001). Compared with sham, RSD was also associated with a significant decrease in daytime ASBP (WMD -4.07 mm Hg, 95% CI: -6.46 to -1.68; p < 0.001), office systolic BP (WMD -5.53 mm Hg, 95% CI: -8.18 to -2.87; p < 0.001), 24-h ambulatory diastolic BP (WMD -1.71 mm Hg, 95% CI: -3.06 to -0.35; p = 0.01), daytime ambulatory diastolic BP (WMD -1.57 mm Hg, 95% CI: -2.73 to -0.42; p = 0.008), and office diastolic BP (WMD -3.37 mm Hg, 95% CI: -4.86 to -1.88; p < 0.001). Compared with first-generation trials, a significantly greater reduction in daytime ASBP was observed with RSD in second-generation trials (6.12 mm Hg vs. 2.14 mm Hg; p interaction = 0.04); however, this interaction was not significant for 24-h ASBP (4.85 mm Hg vs. 2.23 mm Hg; p interaction = 0.13). CONCLUSIONS RSD significantly reduced blood pressure compared with sham control. Results of this meta-analysis should inform the design of larger, pivotal trials to evaluate the long-term efficacy and safety of RSD in patients with hypertension.
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Affiliation(s)
- Partha Sardar
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ajay J Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Kevin F Kennedy
- Mid America Heart and Vascular Institute, St. Luke's Hospital, Kansas City, Missouri
| | - Saurav Chatterjee
- Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter A Soukas
- Division of Cardiology, The Miriam Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Sahil A Parikh
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, Rhode Island.
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Sardar P, Aronow HD. Renal denervation for hypertension: we've come a long way! Cardiovasc Diagn Ther 2020; 9:607-608. [PMID: 32040094 DOI: 10.21037/cdt.2019.09.15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Herbert D Aronow
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Kundu A, Sardar P, Kakouros N, Fisher DZ. Rebuttal: Response to letter by Desch et al. regarding "Outcomes of multivessel vs. culprit lesion-only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta-analysis". Catheter Cardiovasc Interv 2019; 94:896-897. [PMID: 31090240 DOI: 10.1002/ccd.28334] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Amartya Kundu
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Partha Sardar
- Division of Cardiovascular Medicine, Brown University, Providence, Rhode Island
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Daniel Z Fisher
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Kundu A, Sardar P, Malhotra R, Qureshi WT, Kakouros N. Cardiovascular Outcomes with Transcatheter vs. Surgical Aortic Valve Replacement in Low-Risk Patients: An Updated Meta-Analysis of Randomized Controlled Trials. Cardiovasc Revasc Med 2019; 21:453-460. [PMID: 31669113 DOI: 10.1016/j.carrev.2019.08.009] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND TAVR is an established treatment option in high and intermediate-risk patients with severe AS. There is less data regarding the efficacy of TAVR in low-risk patients. This meta-analysis evaluated efficacy and safety outcomes of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis (AS). METHODS Databases were searched for randomized controlled trials (RCTs) that compared TAVR with SAVR for the treatment of low-risk patients with severe AS. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the random-effects model. RESULTS The final analysis included 2953 patients from 5 studies. Compared to SAVR, TAVR was associated with similar mid-term mortality [OR 0.67; 95% CI 0.37-1.21; p = 0.18], as well as similar short-term mortality [OR 0.51; 95% CI 0.24-1.11; p = 0.09]. Randomization to TAVR was associated with a reduced risk of developing acute kidney injury [OR 0.26; 95% CI 0.13-0.52; p < 0.001], short-term major bleeding [OR 0.27; 95% CI 0.12-0.60; p < 0.001] and new-onset atrial fibrillation [OR 0.17; 95% CI 0.14-0.21; p < 0.001]. However, TAVR was associated with a higher risk of requiring permanent pacemaker implantation [OR 4.25; 95% CI 1.86-9.73; p < 0.001]. There was no significant difference in the risk of myocardial infarction, stroke, endocarditis or aortic valve re-intervention between the two groups. CONCLUSIONS Our meta-analysis showed that TAVR has similar clinical efficacy to SAVR, with a more favorable safety profile, in patients with severe AS who are at low-surgical risk.
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Affiliation(s)
- Amartya Kundu
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Partha Sardar
- Division of Cardiology, Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Rohit Malhotra
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Waqas T Qureshi
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Kundu A, Sardar P, Malhotra R, Qureshi W, Kakouros N. TCT-537 Electrophysiological Complications With Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: Evidence From a Meta-Analysis of Randomized Controlled Trials. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Tripathi B, Yeh RW, Bavishi CP, Sardar P, Atti V, Mukherjee D, Bashir R, Abbott JD, Giri J, Chatterjee S. Etiologies, trends, and predictors of readmission in ST‐elevation myocardial infarction patients undergoing multivessel percutaneous coronary intervention. Catheter Cardiovasc Interv 2019; 94:905-914. [DOI: 10.1002/ccd.28344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Byomesh Tripathi
- Division of Cardiology, Banner University Medical CenterUniversity of Arizona Phoenix Arizona
| | - Robert W. Yeh
- Division of Cardiovascular Medicine, Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical Center Boston Massachusetts
| | - Chirag P. Bavishi
- Division of Cardiology, Cardiovascular InstituteWarren Alpert Medical School at Brown University Providence Rhode Island
| | - Partha Sardar
- Division of Cardiology, Cardiovascular InstituteWarren Alpert Medical School at Brown University Providence Rhode Island
| | - Varunsiri Atti
- Department of MedicineMichigan State University East Lansing Michigan
| | - Debabrata Mukherjee
- Division of Cardiology, Texas Tech University Health Sciences Center El Paso Texas
| | - Riyaz Bashir
- Division of CardiologyTemple University Hospital Philadelphia Pennsylvania
| | - Jinnette Dawn Abbott
- Division of Cardiology, Cardiovascular InstituteWarren Alpert Medical School at Brown University Providence Rhode Island
| | - Jay Giri
- Cardiovascular Medicine DivisionHospital of the University of Pennsylvania Philadelphia Pennsylvania
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, Hoffman Heart Institute, Saint Francis HospitalTeaching Affiliate of the University of Connecticut School of Medicine Hartford Connecticut
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Sardar P, Dawn Abbott J. Dual antithrombotic therapy in PCI: Potential harm in routine adoption. Catheter Cardiovasc Interv 2019; 93:E185-E186. [PMID: 30770673 DOI: 10.1002/ccd.27999] [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: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022]
Abstract
Randomized clinical trials support the use of dual antithrombotic therapy (DAT) in PCI patients but outcomes in clinical practice are unclear. In this observational study of patients at high risk for thromboembolism and bleeding, routine use of a P2Y12 inhibitor alone compared with DAPT with OAC was associated with a significantly higher risk of ischemic events without a lower risk of bleeding. Future randomized trials and observational analyses of large registries are needed to select the ideal patient population for DAT.
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Affiliation(s)
- Partha Sardar
- Division of Cardiology, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Division of Cardiology, Rhode Island Hospital, Warren Alpert Medical School at Brown University, Providence, Rhode Island
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Sardar P, Giri J, Jaff MR, Parikh SA, Kundu A, White CJ, Chatterjee S, Kennedy KF, Desai NR, Hyder ON, Mukherjee D, Shishehbor MH, Abbott JD, Aronow HD. Strength of Evidence Underlying the American Heart Association/American College of Cardiology Guidelines on Endovascular and Surgical Treatment of Peripheral Vascular Disease:. Circ Cardiovasc Interv 2019; 12:e007244. [DOI: 10.1161/circinterventions.118.007244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.)
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia (J.G.)
- Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia (J.G.)
| | - Michael R. Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA (M.R.J.)
| | - Sahil A. Parikh
- Center for Interventional Vascular Therapy, Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York Presbyterian Hospital (S.A.P.)
| | - Amartya Kundu
- Cardiovascular Medicine, University of Massachusetts Medical School, Worcester (A.K.)
| | - Christopher J. White
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinical School of the
University of Queensland, Ochsner Medical Center, New Orleans, LA (C.J.W.)
| | - Saurav Chatterjee
- Department of Cardiology, Saint Francis Hospital, Teaching Affiliate, University of Connecticut School of Medicine, Hartford (S.C.)
| | - Kevin F. Kennedy
- Division of Cardiology, Mid America Heart and Vascular Institute, Saint Luke’s Hospital, Kansas City, MO (K.F.K.)
| | - Nihar R. Desai
- Division of Cardiology, Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, CT (N.R.D.)
| | - Omar N. Hyder
- Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.)
| | | | - Mehdi H. Shishehbor
- Division of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (M.H.S.)
| | - J. Dawn Abbott
- Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.)
| | - Herbert D. Aronow
- Division of Cardiology, Cardiovascular Institute, Warren Alpert Medical School at Brown University, Providence, RI (P.S., O.N.H., J.D.A., H.D.A.)
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24
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Gopan A, Sahu N, Varghese T, Sardar P, Gupta S, Gupta G, Maiti M. Preparation of Protein Isolate from Neem Seed: Biochemical Evaluation, Antinutrients and In Vitro Digestibility Study. ANIM NUTR FEED TECHN 2019. [DOI: 10.5958/0974-181x.2019.00019.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Kundu A, Sardar P, Kakouros N, Malhotra R, Kolte D, Feldman DN, Abbott JD, Fisher DZ. Outcomes of multivessel vs culprit lesion-only percutaneous coronary intervention in patients with acute myocardial infarction complicated by cardiogenic shock: Evidence from an updated meta-analysis. Catheter Cardiovasc Interv 2018; 94:70-81. [DOI: 10.1002/ccd.28062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/16/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Amartya Kundu
- Division of Cardiovascular Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Partha Sardar
- Division of Cardiovascular Medicine; Brown University; Providence Rhode Island
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Rohit Malhotra
- Division of Cardiovascular Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Dhaval Kolte
- Division of Cardiovascular Medicine; Massachusetts General Hospital; Boston Massachusetts
| | - Dmitriy N. Feldman
- Division of Cardiovascular Medicine; Weill Cornell Medical College; New York New York
| | - JD Abbott
- Division of Cardiovascular Medicine; Brown University; Providence Rhode Island
| | - Daniel Z. Fisher
- Division of Cardiovascular Medicine; University of Massachusetts Medical School; Worcester Massachusetts
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26
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Cirulis MM, Huston JH, Sardar P, Suksaranjit P, Wilson BD, Hatton ND, Liou TG, Ryan JJ. Right-to-left ventricular end diastolic diameter ratio in severe sepsis and septic shock. J Crit Care 2018; 48:307-310. [PMID: 30273910 DOI: 10.1016/j.jcrc.2018.09.025] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The ratio of right ventricular end-diastolic diameter (EDD) to left ventricular EDD (RV/LV) is a measure predictive of right ventricular failure. We hypothesized that an increase in RV/LV would be associated with poor prognosis in severe sepsis and septic shock. MATERIALS AND METHODS This is a retrospective chart review of patients with severe sepsis and septic shock admitted to a medical intensive care unit (ICU) at a single tertiary care hospital. Patients were identified by ICD-9 codes: 995.92 for severe sepsis and 785.52 for septic shock; and had to have an echocardiogram within 48 h of ICU admission. Increased RV/LV was defined as RV/LV ≥ 0.9. Left and right-sided chamber dimensions were measured according to American Society of Echocardiography guidelines. RESULTS We included 146 consecutive ICU patients admitted with septic shock (72) or severe sepsis (74). There was no significant difference in ICU mortality in patients with RV/LV ≥ 0.9 versus RV/LV < 0.9 (p = .49). CONCLUSIONS An increased RV/LV does not predict mortality in severe sepsis or septic shock.
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Affiliation(s)
- Meghan M Cirulis
- Division of Pulmonary Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jessica H Huston
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, TN, United States; Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Partha Sardar
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Promporn Suksaranjit
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Brent D Wilson
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Nathan D Hatton
- Division of Pulmonary Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Theodore G Liou
- Division of Pulmonary Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States.
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27
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Kundu A, Sardar P, Chatterjee S, Bavishi C, Kakouros N, Aronow H, Rade J. TCT-521 Long Term Cardiovascular Outcomes with Drug-Eluting Stents vs. Bare-Metal Stents in Saphenous Vein Graft Interventions: Insights from an Updated Meta-Analysis of Randomized Controlled Trials. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Kumar P, Jain KK, Sardar P. Effects of dietary synbiotic on innate immunity, antioxidant activity and disease resistance of Cirrhinus mrigala juveniles. Fish Shellfish Immunol 2018; 80:124-132. [PMID: 29857133 DOI: 10.1016/j.fsi.2018.05.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
The dietary supplementation of synbiotic in Cirrhinus mrigala juvenile (with initial body weight ranging from 2.87 ± 0.01 g to 3.26 ± 0.05 g) was evaluated in terms of changes in innate immunity, antioxidant activity and disease resistance against Aeromonas hydrophilla infection. One hundred eighty acclimatized juveniles of mrigal were randomly distributed in the three replicates of each of four experimental groups i.e. control (without Probiotic and Prebiotic), T1 (High Probiotic + Low Prebiotic), T2 (Low Probiotic + High Prebiotic) and T3 (High Probiotic + High Prebiotic), using completely randomized design (CRD). At the end of the feeding trial for 60 days, fish were challenged by Aeromonas hydrophila and survival rate was recorded for the next 15 days. Bacillus subtilis used as a probiotic source and MOS used as a prebiotic source in the experiment. Results showed that innate immunity was comparatively improved in T3 group. Lysozyme activity and respiratory burst activity (NBT) were significantly (P < 0.05) affected in T3 group. Highest activities of antioxidant enzymes (P < 0.05) were reported in T3 group. Cumulative mortality % was found to be lower in the fish fed dietary synbiotic on T3 group after challenging with Aeromonas hydrophilla infection. The results of this study showed that under the experimental conditions, dietary supplementation of synbiotic had a synergestic effect on enhancing innate immunity and disease resistance of Cirrhinus mrigala (P < 0.05).
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Affiliation(s)
- Pankaj Kumar
- ICAR-Central Institute of Fisheries Education, Rohtak Centre, Lahli, 124411, Haryana, India.
| | - K K Jain
- Department of Fish Nutrition, Biochemistry and Physiology, Central Institute of Fisheries Education, Fisheries University Road, Versova, Mumbai, 400 061, India
| | - P Sardar
- Department of Fish Nutrition, Biochemistry and Physiology, Central Institute of Fisheries Education, Fisheries University Road, Versova, Mumbai, 400 061, India
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Abstract
PURPOSE OF REVIEW Variant angina, which is characterized by recurrent chest pain and transient ECG changes along with angiographic evidence of coronary artery spasm, generally has a favorable prognosis. However, episodes of ischemia caused by vasospasm may lead to potentially life-threatening ventricular arrhythmias and cardiac arrest, even in patients with no history of prior cardiac disease. This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD). RECENT FINDINGS Contrary to prior opinions, evidence from recent observational studies indicate that patients with variant angina presenting with ASCD face a worse prognosis than those without this type of presentation. Predictors of ASCD include age, hypertension, hyperlipidemia, family history of sudden cardiac death, multi-vessel spasm, and left anterior descending artery spasm. Medical therapy alone with calcium channel blockers and nitrates may not be sufficiently protective in these patients and there is lack of concrete data on the optimal management strategy. Current guidelines recommend implantable cardiac defibrillator (ICD) therapy in patients who are survivors of cardiac arrest caused by ventricular fibrillation or unstable ventricular tachycardia after reversible causes are excluded, and should strongly be considered in these patients. Although medical therapy is absolutely imperative for patients with variant angina and a history of ASCD, ICD therapy in these patients is justified. Further large-scale studies are required to determine whether ICD therapy can improve survival in this high-risk group of patients.
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Affiliation(s)
- Amartya Kundu
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA.
| | - Aditya Vaze
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Partha Sardar
- Department of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ahmed Nagy
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Naomi F Botkin
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
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Chatterjee S, Sardar P, Giri J, Mukherjee D. CRT-100.77 Trends In National Hospitalization Rates With Abnormal Stress Tests - Impact of the COURAGE Trial. JACC Cardiovasc Interv 2018. [DOI: 10.1016/j.jcin.2018.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Phulia V, Sardar P, Sahu N, Sanap B, Shamna N, Fawole F, Gupta S. Effect of Detoxification Methods on Anti-nutritional Factors and Proximate Composition of Defatted Jatropha curcas Kernel Meal. ANIM NUTR FEED TECHN 2018. [DOI: 10.5958/0974-181x.2018.00006.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Saad M, Nairooz R, Pothineni NVK, Almomani A, Kovelamudi S, Sardar P, Katz M, Abdel-Wahab M, Bangalore S, Kleiman NS, Block PC, Abbott JD. Long-Term Outcomes With Transcatheter Aortic Valve Replacement in Women Compared With Men. JACC Cardiovasc Interv 2018; 11:24-35. [DOI: 10.1016/j.jcin.2017.08.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/24/2017] [Accepted: 08/02/2017] [Indexed: 11/25/2022]
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Chatterjee S, Weinberg I, Yeh RW, Chakraborty A, Sardar P, Weinberg MD, Kabrhel C, Barnes GD, Mukherjee D, Kumbhani D, Bashir R, Vaidya A, Smith A, Fuchs B, Groeneveld P, Giri J. Risk factors for intracranial haemorrhage in patients with pulmonary embolism treated with thrombolytic therapy Development of the PE-CH Score. Thromb Haemost 2017; 117:246-251. [DOI: 10.1160/th16-07-0588] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/19/2016] [Indexed: 11/05/2022]
Abstract
SummaryPulmonary embolism (PE) is a major cause of morbidity and mortality world-wide, and the use of thrombolytic therapy has been associated with favourable clinical outcomes in certain patient subsets. These potential benefits are counterbalanced by the risk of bleeding complications, the most devastating of which is intracranial haemorrhage (ICH). We retrospectively evaluated 9703 patients from the 2003–2012 nationwide in-patient sample database (NIS) who received thrombolytics for PE. All patients with ICH during the PE hospitalisation were identified and a clinical risk score model was developed utilizing demographics and comorbidities. The dataset was divided 1:1 into derivation and validation cohorts. During 2003–2012, 176/9705 (1.8 %) patients with PE experienced ICH after thrombolytic use. Four independent prognostic factors were identified in a backward logistic regression model, and each was assigned a number of points proportional to its regression coefficient: pre-existing Peripheral vascular disease (1 point), age greater than 65 years (Elderly) (1 point), prior Cerebrovascular accident with residual deficit (5 points), and prior myocardial infarction (Heart attack) (1 point). In the derivation cohort, scores of 0, 1, 2 and ≥ 5 points were associated with ICH risks of 1.2 %, 1.9 %, 2.4 % and 17.8 %, respectively. Rates of ICH were similar in the validation cohort. The C-statistic for the risk score was 0.65 (0.61–0.70) in the derivation cohort and 0.66 (0.60–0.72) in the validation cohort. A novel risk score, derived from simple clinical historical elements was developed to predict ICH in PE patients treated with thrombolytics.Supplementary Material to this article is available online at www.thrombosis-online.com.
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Marmagkiolis K, Sardar P, Mustapha JA, Montero-Baker M, Charitakis K, Iliescu C, Feldman DN. Transpedal Access for the Management of Complex Peripheral Artery Disease. J Invasive Cardiol 2017; 29:425-429. [PMID: 29207364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of transpedal access for the management of complex peripheral artery disease (PAD). INTRODUCTION Critical limb ischemia is associated with high risk of limb loss, as well as cardiovascular and all-cause mortality. Transpedal access is a novel, increasingly utilized technique for the management of complex PAD. METHODS We performed a literature search using PubMed from January 2003 to December 2016. Published studies on transpedal access were studied. We evaluated patient sample demographics, procedure indications, access and target vessel, procedural characteristics, outcomes, and complications. RESULTS Ten studies and 881 patients were included in our study. The indication for transpedal access was critical limb ischemia in 68.4% and severe claudication in 29.5%. A chronic total occlusion was present in 93.7% (average occlusion length, 206 mm). Access was achieved by ultrasound in 57.1% and by fluoroscopy in 35.7%. The anterior tibial or dorsalis pedis were accessed in 54.7% and the posterior tibial in 28.0%. The angiographic procedural success rate was 92.6%. The most commonly reported complication was dissection (7.49%), followed by perforation (1.36%) and embolization (1.25%). CONCLUSION Based on the results of this systematic review, transpedal access appears to be a safe and effective technique for complex PAD.
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35
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Kolte D, Sardar P, Khera S, Zeymer U, Thiele H, Hochadel M, Radovanovic D, Erne P, Hambraeus K, James S, Claessen BE, Henriques JP, Mylotte D, Garot P, Aronow WS, Owan T, Jain D, Panza JA, Frishman WH, Fonarow GC, Bhatt DL, Aronow HD, Abbott JD. Culprit Vessel–Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005582. [PMID: 29146672 DOI: 10.1161/circinterventions.117.005582] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Dhaval Kolte
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Partha Sardar
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Sahil Khera
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Uwe Zeymer
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Holger Thiele
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Matthias Hochadel
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Dragana Radovanovic
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Paul Erne
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Kristina Hambraeus
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Stefan James
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Bimmer E. Claessen
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Jose P.S. Henriques
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Darren Mylotte
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Philippe Garot
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Wilbert S. Aronow
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Theophilus Owan
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Diwakar Jain
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Julio A. Panza
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - William H. Frishman
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Gregg C. Fonarow
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Deepak L. Bhatt
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - Herbert D. Aronow
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
| | - J. Dawn Abbott
- From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.); Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.); Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.); Department of Cardiology, University Heart
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Sardar P, Giri J, Elmariah S, Chatterjee S, Kolte D, Kundu A, Nairooz R, Aronow WS, Owan T, Mukherjee D, Feldman DN, Abbott JD. Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing. Am J Cardiol 2017; 119:1746-1752. [PMID: 28400029 DOI: 10.1016/j.amjcard.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are increasingly treated with percutaneous coronary intervention (PCI) using new-generation drug-eluting stents (DES); however, the benefits of DES compared with coronary artery bypass grafting (CABG) in ULMCA remain controversial. This meta-analysis evaluated the effects of PCI with DES compared with CABG for the treatment of ULMCA stenosis. Databases were searched through November 30, 2016. Randomized controlled trials (RCTs) comparing DES with PCI versus CABG for ULMCA stenosis were identified. We calculated summary odds ratios (ORs) and 95% CIs with the random-effects model. The primary outcome was major adverse cardiovascular events, defined as a composite of death from any cause, stroke, or myocardial infarction (MI). The analysis included 4,612 patients from 5 RCTs. Compared with CABG, patients assigned to PCI had a similar rate of major adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03, 95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR 1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was significantly greater in the PCI group than that in the CABG group (OR 1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs suggest that PCI with DES results in comparable mortality, stroke, and MI compared with CABG for revascularization of ULMCA stenosis, with PCI associated with higher rates of repeat revascularization.
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Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Saurav Chatterjee
- Cardiology Division, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Dhaval Kolte
- Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
| | - Amartya Kundu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ramez Nairooz
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Wilbert S Aronow
- Division of Cardiovascular Medicine, Westchester Medical Center-New York Medical College, New York, New York
| | - Theophilus Owan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - J Dawn Abbott
- Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
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Sardar P, Kundu A, Bischoff M, Chatterjee S, Owan T, Nairooz R, Giri J, Halkos ME, Liberman H, Douglas JS, Mukherjee D. Hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:203-212. [DOI: 10.1002/ccd.27098] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/16/2017] [Accepted: 03/23/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | | | - Saurav Chatterjee
- Division of Cardiovascular Medicine; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Theophilus Owan
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Ramez Nairooz
- Division of Cardiovascular Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Jay Giri
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Michael E. Halkos
- Division of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Henry Liberman
- Clinical Research Unit, Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - John S. Douglas
- Clinical Research Unit, Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine; Texas Tech University Health Sciences Center; El Paso Texas
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Sardar P, Kundu A, Chatterjee S, Feldman DN, Owan T, Kakouros N, Nairooz R, Pape LA, Feldman T, Dawn Abbott J, Elmariah S. Transcatheter versus surgical aortic valve replacement in intermediate-risk patients: Evidence from a meta-analysis. Catheter Cardiovasc Interv 2017; 90:504-515. [DOI: 10.1002/ccd.27041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/26/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Saurav Chatterjee
- Division of Cardiology; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Dmitriy N. Feldman
- Division of Cardiology; Weill Cornell Medical College, New York Presbyterian Hospital; New York New York
| | - Theophilus Owan
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Nikolaos Kakouros
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Ramez Nairooz
- University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Linda A. Pape
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Ted Feldman
- Department of Medicine; Division of Cardiology, Evanston Hospital; Evanston Illinois
| | - J. Dawn Abbott
- Division of Cardiology; Brown Medical School, Rhode Island Hospital; Providence Rhode Island
| | - Sammy Elmariah
- Cardiology Division; Department of Medicine, Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
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Nairooz R, Saad M, Elgendy IY, Mahmoud AN, Habash F, Sardar P, Anderson D, Shavelle DM, Abbott JD. Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials. Heart 2017; 103:1427-1434. [DOI: 10.1136/heartjnl-2016-310929] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 01/17/2023] Open
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40
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Nairooz RS, Pothineni NV, Sardar P, Chatterjee S, Abbott J, Shavelle D. NATIONAL AND REGIONAL TRENDS IN SURGICAL AORTIC VALVE REPLACEMENT IN THE TAVR ERA. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nairooz RS, Saad M, Sardar P. LONG-TERM OUTCOMES OF ABSORB BIORESORBABLE VASCULAR SCAFFOLD VERSUS SECOND GENERATION DES IN CORONARY ARTERY DISEASE: A META-ANALYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34638-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Sardar P. CRT-100.64 Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting in Patients with Multivessel Coronary Artery Disease, A Meta-Analysis. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chatterjee S, Kundu A, Mukherjee D, Sardar P, Mehran R, Bashir R, Giri J, Abbott JD. Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel intervention-meta-analysis of randomized trials and risk prediction modeling study using observational data. Catheter Cardiovasc Interv 2017; 90:205-212. [DOI: 10.1002/ccd.26928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Saurav Chatterjee
- Division of Cardiology; St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System; New York New York
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | - Debabrata Mukherjee
- Division of Cardiology; Texas Tech University Health Sciences Center; El Paso Texas
| | - Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Roxana Mehran
- Director of Interventional Research, Icahn School of Medicine, Mount Sinai Health System; New York New York
| | - Riyaz Bashir
- Division of Cardiology; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Jay Giri
- Penn Cardiovascular Outcomes; Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania; Philadelphia PA
| | - Jinnette D. Abbott
- Warren Alpert School of Medicine and Brown University; Rhode Island Hospital; Providence Rhode Island
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Nairooz R, Saad M, Sardar P, Aronow WS. Two-year outcomes of bioresorbable vascular scaffold versus drug-eluting stents in coronary artery disease: a meta-analysis. Heart 2017; 103:1096-1103. [PMID: 28115471 DOI: 10.1136/heartjnl-2016-310886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/10/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Data regarding long-term clinical outcomes with everolimus-eluting bioresorbable vascular scaffold (BVS) versus second-generation drug-eluting stents (DES) are scarce. METHODS We searched online databases until October 2016 for studies comparing BVS versus DES reporting outcomes at 2 years of follow-up. We performed a meta-analysis comparing BVS with DES across the spectrum of coronary artery disease (CAD). Random effects model OR was calculated for outcomes of interest including device-oriented composite events (DOCE; defined as composite of cardiac mortality, target vessel myocardial infarction (TV-MI), and ischaemia-driven target lesion revascularisation (TLR)), all-cause mortality, definite stent thrombosis, TV-MI and TLR. RESULTS A total of 2360 patients enrolled in five studies met criteria for inclusion in this analysis. At 2 years, BVS was associated with higher rates of DOCE (6.9% vs 4.5%, OR=1.53; 95% CI 1.06 to 2.23; p=0.02), absolute risk increase (ARI) 2.4%, relative risk increase (RRI) 53%, TV-MI (4% vs 1.8%, OR=1.94; 95% CI 1.02 to 3.67; p=0.04), ARI 2.2%, RRI 122% and definite stent thrombosis (2.1% vs 0.6%, OR=3.39; 95% CI 1.46 to 7.88; p=0.005), ARI 1.5%, RRI 250% compared with DES. No differences in all-cause mortality (OR=0.86; 95% CI 0.26 to 2.81; p=0.80) and TLR (OR=1.44; 95% CI 0.81 to 2.54; p=0.21) were observed between both groups. CONCLUSIONS BVS may be associated with worse long-term clinical outcomes compared with DES. Randomised clinical trials are encouraged to expeditiously report long-term safety and efficacy outcomes and identify predictors of adverse events with BVS compared with DES.
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Affiliation(s)
- Ramez Nairooz
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Utah, USA
| | - Wilbert S Aronow
- Division of Cardiovascular Medicine, Westchester Medical Center-New York Medical College, New York, USA
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Sardar P, Kundu A, Chatterjee S, Nohria A, Nairooz R, Bangalore S, Mukherjee D, Aronow WS, Lavie CJ. Long-term cardiovascular mortality after radiotherapy for breast cancer: A systematic review and meta-analysis. Clin Cardiol 2016; 40:73-81. [PMID: 28244595 DOI: 10.1002/clc.22631] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 05/12/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is frequently associated with late cardiovascular (CV) complications. The mean cardiac dose from irradiation of a left-sided breast cancer is much higher than that for a right-sided breast cancer. However, data is limited on the long-term risks of RT on CV mortality. HYPOTHESIS RT for breast cancer is associated with long term CV mortality and left sided RT carries a greater mortality than right sided RT. METHODS We searched PubMed, Cochrane Central, Embase, EBSCO, Web of Science, and CINAHL databases from inception through December 2015. Studies reporting CV mortality with RT for left- vs right-sided breast cancers were included. The principal outcome of interest was CV mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random-effects model. RESULTS The analysis included 289 109 patients from 13 observational studies. Women who had received RT for left-sided breast cancer had a higher risk of CV death than those who received RT for a right-sided breast cancer (RR: 1.12, 95% CI: 1.07-1.18, P < 0.001; number needed to harm: 353). Difference in CV mortality between left- vs right-sided breast RT was more apparent after 15 years of follow-up (RR: 1.23, 95% CI: 1.08-1.41, P < 0.001; number needed to harm: 95). CONCLUSIONS CV mortality from left-sided RT was significantly higher compared with right-sided RT for breast cancer and was more apparent after ≥15 years of follow-up.
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Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City
| | - Amartya Kundu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Saurav Chatterjee
- St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, New York
| | - Anju Nohria
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramez Nairooz
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School/University of Queensland School of Medicine, New Orleans, Louisiana
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Sardar P, Chatterjee S, Kundu A, Samady H, Owan T, Giri J, Nairooz R, Selzman CH, Heusch G, Gersh BJ, Abbott JD, Mukherjee D, Fang JC. Remote ischemic preconditioning in patients undergoing cardiovascular surgery: Evidence from a meta-analysis of randomized controlled trials. Int J Cardiol 2016; 221:34-41. [PMID: 27400294 DOI: 10.1016/j.ijcard.2016.06.325] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 04/22/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Remote ischemic preconditioning (RIPC) has been associated with reduced risk of myocardial injury in patients undergoing cardiovascular surgery, but uncertainty about clinical outcomes remains, particularly in the light of 2 recent large randomized clinical trials (RCTs) which were neutral. We performed a meta-analysis to evaluate the efficacy of RIPC on clinically relevant outcomes in patients undergoing cardiovascular surgery. METHODS We searched PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through November 30, 2015. RCTs that compared the effects of RIPC vs. control in patients undergoing cardiac and/or vascular surgery were selected. We calculated summary random-effect odds ratios (ORs) and 95% confidence intervals (CI). RESULTS The analysis included 5652 patients from 27 RCTs. RIPC reduced the risk of myocardial infarction (MI) (OR 0.72, 95% CI, 0.52 to 1.00; p=0.05; number needed to treat (NNT)=42), acute renal failure (OR 0.73, 95% CI, 0.53 to 1.00; p=0.05; NNT=44) as well as the composite of all cause mortality, MI, stroke or acute renal failure (OR 0.60, 95% CI, 0.39 to 0.90; p=0.01; NNT=25). No significant difference between RIPC and the control groups was observed for the outcome of all-cause mortality (OR 1.10, 95% CI, 0.81 to 1.51). Randomization to RIPC group was also associated with significantly shorter hospital stay (weighted mean difference -0.15days; 95% CI -0.27 to -0.03days). CONCLUSIONS RIPC did not decrease overall mortality, but was associated with less MI and acute renal failure and shorter hospitalizations in patients undergoing cardiac or vascular surgery.
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Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States.
| | - Saurav Chatterjee
- St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, NY, United States
| | - Amartya Kundu
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Theophilus Owan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Ramez Nairooz
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT,United States
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Hufelandstr. 55, 45122 Essen, Germany
| | - Bernard J Gersh
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN, United States
| | - J Dawn Abbott
- Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | | | - James C Fang
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, United States
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Chatterjee S, Yeh RW, Sardar P, Ul Hassan Virk H, Mukherjee D, Parikh SA, Kumbhani DJ, Kirtane A, Bashir R, Cohen H, Kolansky DM, Wilensky RL, Giri J. Is multivessel intervention in ST-elevation myocardial infarction associated with early harm? Insights from observational data. Catheter Cardiovasc Interv 2016; 88:697-707. [DOI: 10.1002/ccd.26643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/05/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Saurav Chatterjee
- Division of Cardiology; St. Lukes-Roosevelt Hospitals of the Mount Sinai Health System; New York New York
| | - Robert W. Yeh
- Division of Cardiology; Massachusetts General Hospital; Boston Massachusetts
| | - Partha Sardar
- Division of Cardiology; University of Utah; Salt Lake City Utah
| | - Hafeez Ul Hassan Virk
- Division of Cardiology; St. Lukes-Roosevelt Hospitals of the Mount Sinai Health System; New York New York
| | | | - Sahil A. Parikh
- Cardiovascular Medicine Division; University Hospitals Case Medical Center, Harrington Heart and Vascular Institute and Case Western Reserve University School of Medicine; Cleveland Ohio
| | - Dharam J. Kumbhani
- Division of Cardiology; University of Texas Southwestern Medical School; Dallas Texas
| | - Ajay Kirtane
- Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital; New York New York
| | - Riyaz Bashir
- Division of Cardiology; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Howard Cohen
- Division of Cardiology; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Daniel M. Kolansky
- Cardiovascular Medicine Division; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Robert L. Wilensky
- Cardiovascular Medicine Division; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
| | - Jay Giri
- Cardiovascular Medicine Division; Perelman School of Medicine, University of Pennsylvania; Philadelphia Pennsylvania
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Kundu A, Sardar P, Ghosh S, Patel P, Chatterjee S, Meyer TE. Risk of heart failure with dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Int J Cardiol 2016; 212:203-5. [DOI: 10.1016/j.ijcard.2016.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/12/2016] [Indexed: 12/27/2022]
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Hassan H, Kallur KR, Chatterjee S, Bavishi C, Gongora C, Palazzo A, Herzog E, Mukherjee D, Sardar P, Kornberg R. ROLE OF EARLY CORONARY INTERVENTION IN IMPROVING IN-HOSPITAL MORTALITY IN COMATOSE CARDIAC ARREST PATIENTS WITHOUT ST ELEVATION MYOCARDIAL INFARCTION: A META-ANALYSIS OF OBSERVATIONAL STUDIES. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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