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Ali A, Jewani P, Bourdillon M, Koutroumpakis E, Khalaf S, Charitakis K, Thompson K, Marmagkiolis K, Deswal A, Iliescu C. Navigating P2Y12 inhibition in the labyrinth of cardio-oncology care: cangrelor bridging in patients with cancer. Front Cardiovasc Med 2024; 11:1337957. [PMID: 38486704 PMCID: PMC10937743 DOI: 10.3389/fcvm.2024.1337957] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Cangrelor, a potent intravenous P2Y12 platelet inhibitor, has demonstrated effectiveness in reducing ischemic events without a corresponding increase in severe bleeding during percutaneous coronary intervention, as evidenced by the CHAMPION-PHOENIX trial. Its off-label role as a bridging antiplatelet agent for patients facing high thrombotic risks who must temporarily stop oral P2Y12 inhibitor therapy further underscores its clinical utility. This is the first case series to shed light on the application of cangrelor in cancer patients needing to pause dual antiplatelet therapy for a range of medical interventions, marking it as a pioneering effort in this domain. The inclusion of patients with a variety of cancer types and cardiovascular conditions in this series underlines the adaptability and critical role of cangrelor in managing the dual challenges of bleeding risk and the need for uninterrupted antiplatelet protection. By offering a bridge for high-risk cancer patients who have recently undergone percutaneous coronary intervention and need to halt oral P2Y12 inhibitors temporarily, cangrelor presents a practical solution. Early findings indicate it can be discontinued safely 2-4 h before medical procedures, allowing for the effective reintroduction of oral P2Y12 inhibitors without adverse effects. This evidence calls for expanded research to validate and extend these preliminary observations, emphasizing the importance of further investigation into cangrelor's applications in complex patient care scenarios.
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Affiliation(s)
- Abdelrahman Ali
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Poonam Jewani
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Max Bourdillon
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas, Houston, TX, United States
| | | | - Shaden Khalaf
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Konstantinos Charitakis
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas, Houston, TX, United States
| | - Kara Thompson
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | | | - Anita Deswal
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
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2
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Gould KL, Johnson NP, Roby AE, Bui L, Kitkungvan D, Patel MB, Nguyen T, Kirkeeide R, Haynie M, Arain SA, Charitakis K, Dhoble A, Smalling R, Nascimbene A, Jumean M, Kumar S, Kar B, Sdringola S, Estrera A, Gregoric I, Lai D, Li R, McPherson D, Narula J. Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications. Eur Heart J 2024; 45:181-194. [PMID: 37634192 PMCID: PMC10787661 DOI: 10.1093/eurheartj/ehad579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. METHODS Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. RESULTS Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). CONCLUSIONS Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.
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Affiliation(s)
- K Lance Gould
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Nils P Johnson
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Amanda E Roby
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Linh Bui
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Danai Kitkungvan
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Monica B Patel
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Tung Nguyen
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Richard Kirkeeide
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Mary Haynie
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Salman A Arain
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Konstantinos Charitakis
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Abhijeet Dhoble
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Richard Smalling
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Marwan Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Stefano Sdringola
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Anthony Estrera
- Department of Cardiothoracic Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Hospital, Houston, TX, USA
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Dejian Lai
- Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA
| | - Ruosha Li
- Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA
| | - David McPherson
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Jagat Narula
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
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3
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Bourdillon MT, Charitakis K. Direct Oral Anticoagulants in the Setting of Percutaneous Coronary Intervention: "There Will Be Blood". Am J Cardiol 2023; 204:415-416. [PMID: 37574355 DOI: 10.1016/j.amjcard.2023.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Maximillian T Bourdillon
- Department of Medicine, University of Texas Health Science Center at Houston, Memorial Hermann Heart and Vascular Institute-TMC/UTHealth-McGovern Medical School, Houston, Texas
| | - Konstantinos Charitakis
- Department of Medicine, University of Texas Health Science Center at Houston, Memorial Hermann Heart and Vascular Institute-TMC/UTHealth-McGovern Medical School, Houston, Texas.
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Ahmed T, Charitakis K. Overcoming Hurdles During Transcatheter Aortic Valve Implantation in Patients With a Previous Coronary Artery Bypass Surgery: "In the Middle of Difficulty, Lies Opportunity." Albert Einstein. Am J Cardiol 2023; 203:509-510. [PMID: 37500319 DOI: 10.1016/j.amjcard.2023.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Talha Ahmed
- Memorial Hermann Heart and Vascular Institute at Texas Medical Center, UTHealth-McGovern Medical School, Houston, Texas
| | - Konstantinos Charitakis
- Memorial Hermann Heart and Vascular Institute at Texas Medical Center, UTHealth-McGovern Medical School, Houston, Texas.
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Gerontas A, Avgerinos D, Charitakis K, Maragou H, Drosatos K. Corrigendum: 1821-2021: contributions of physicians and researchers of Greek descent in the advancement of clinical and experimental cardiology and cardiac surgery. Front Cardiovasc Med 2023; 10:1282686. [PMID: 37745111 PMCID: PMC10513762 DOI: 10.3389/fcvm.2023.1282686] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2023.1231762.].
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Affiliation(s)
- Apostolos Gerontas
- School of Applied Natural Sciences, Coburg University, Coburg, Germany
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Dimitrios Avgerinos
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, TX, United States
| | - Helena Maragou
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Konstantinos Drosatos
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
- Metabolic Biology Laboratory, Cardiovascular Center, Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Gerontas A, Avgerinos D, Charitakis K, Maragou H, Drosatos K. 1821-2021: Contributions of physicians and researchers of Greek descent in the advancement of clinical and experimental cardiology and cardiac surgery. Front Cardiovasc Med 2023; 10:1231762. [PMID: 37600045 PMCID: PMC10436502 DOI: 10.3389/fcvm.2023.1231762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
While the role of Greeks in the development of early western medicine is well-known and appreciated, the contributions of modern Greek medical practitioners are less known and often overlooked. On the occasion of the 200-year anniversary of the Greek War of Independence, this review article sheds light onto the achievements of modern scientists of Greek descent in the development of cardiology, cardiac surgery, and cardiovascular research, through a short history of the development of these fields and of the related institutions in Greece. In the last decades, the Greek cardiology and Cardiac Surgery communities have been active inside and outside Greece and have a remarkable presence internationally, particularly in the United States. This article highlights the ways in which Greek cardiology and cardiovascular research has been enriched by absorbing knowledge produced in international medical centers, academic institutes and pharmaceutical industries in which generations of Greek doctors and researchers trained prior to their return to the homeland; it also highlights the achievements of medical practitioners and researchers of Greek descent who excelled abroad, producing ground-breaking work that has left a permanent imprint on global medicine.
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Affiliation(s)
- Apostolos Gerontas
- School of Applied Natural Sciences, Coburg University, Coburg, Germany
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Dimitrios Avgerinos
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, TX, United States
| | - Helena Maragou
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Konstantinos Drosatos
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
- Metabolic Biology Laboratory, Cardiovascular Center, Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Shoar S, Sharma SK, Charitakis K. COMPARISON OF FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS UNDERGOING TRANSCATHETER (TAVR) AND SURGICAL AORTIC VALVE REPLACEMENT (SAVR) IN THE UNITED STATES: AN INSIGHT FROM THE NATIONAL INPATIENT SAMPLE DATA 2019. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01537-1] [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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Amatullah A, Irizarry-Caro JA, Hoang K, Ma J, Yarrabothula AR, Haque K, Salman J, Goenka KV, Lobo N, Dhoble A, Charitakis K, Owen B. E. COLI BACTERIAL PERICARDITIS ASSOCIATED WITH SPONTANEOUS BACTERIAL PERITONITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03923-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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9
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Ahmed T, Pacha HM, Addoumieh A, Koutroumpakis E, Song J, Charitakis K, Boudoulas KD, Cilingiroglu M, Marmagkiolis K, Grines C, Iliescu CA. Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents. Front Cardiovasc Med 2022; 9:901431. [DOI: 10.3389/fcvm.2022.901431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundManagement of coronary artery disease (CAD) is unique and challenging in cancer patients. However, little is known about the outcomes of using BMS or DES in these patients. This study aimed to compare the outcomes of percutaneous coronary intervention (PCI) in cancer patients who were treated with bare metal stents (BMS) vs. drug-eluting stents (DES).MethodsWe identified cancer patients who underwent PCI using BMS or DES between 2013 and 2020. Outcomes of interest were overall survival (OS) and the number of revascularizations. The Kaplan–Meier method was used to estimate the survival probability. Multivariate Cox regression models were utilized to compare OS between BMS and DES.ResultsWe included 346 cancer patients who underwent PCI with a median follow-up of 34.1 months (95% CI, 28.4–38.7). Among these, 42 patients were treated with BMS (12.1%) and 304 with DES (87.9%). Age and gender were similar between the BMS and DES groups (p = 0.09 and 0.93, respectively). DES use was more frequent in the white race, while black patients had more BMS (p = 0.03). The use of DES was more common in patients with NSTEMI (p = 0.03). The median survival was 46 months (95% CI, 34–66). There was no significant difference in the number of revascularizations between the BMS and DES groups (p = 0.43). There was no significant difference in OS between the BMS and DES groups in multivariate analysis (p = 0.26). In addition, independent predictors for worse survival included age > 65 years, BMI ≤ 25 g/m2, hemoglobin level ≤ 12 g/dL, and initial presentation with NSTEMI.ConclusionsIn our study, several revascularizations and survival were similar between cancer patients with CAD treated with BMS and DES. This finding suggests that DES use is not associated with an increased risk for stent thrombosis, and as cancer survival improves, there may be a more significant role for DES.
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Javaid AI, Monlezun DJ, Iliescu G, Tran P, Filipescu A, Palaskas N, Lopez-Mattei J, Hassan S, Kim P, Madjid M, Cilingiroglu M, Charitakis K, Marmagkiolis K, Iliescu C, Koutroumpakis E. Stress cardiomyopathy in hospitalized patients with cancer: machine learning analysis by primary malignancy type. ESC Heart Fail 2021; 8:4626-4634. [PMID: 34612022 PMCID: PMC8712856 DOI: 10.1002/ehf2.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/17/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
Aims Previous studies have shown that patients with stress (Takotsubo) cardiomyopathy (SC) and cancer have higher in‐hospital mortality than patients with SC alone. No studies have examined outcomes in patients with active cancer and SC compared to patients with active cancer without SC. We aimed to assess the potential association between primary malignancy type and SC and their shared interaction with inpatient mortality. Methods and results We analysed SC by primary malignancy type with propensity score adjusted multivariable regression and machine learning analysis using the 2016 United States National Inpatient Sample. Of 30 195 722 adult hospitalized patients, 4 719 591 had active cancer, of whom 568 239 had SC. The mean age of patients with cancer and SC was 69.1, of which 74.7% were women. Among patients with cancer, those with SC were more likely to be female and have white race, Medicare insurance, hypertension, heart failure with reduced ejection fraction, obesity, cerebrovascular disease, anaemia, and chronic obstructive pulmonary disease (P < 0.003 for all). In machine learning‐augmented, propensity score multivariable regression adjusted for age, race, and income, only lung cancer [OR 1.25; 95% CI: 1.08–1.46; P = 0.003] and breast cancer [OR 1.81; 95% CI: 1.62–2.02; P < 0.001] were associated with a significantly increased likelihood of SC. Neither SC alone nor having both SC and cancer was significantly associated with in‐hospital mortality. The presence of concomitant SC and breast cancer was significantly associated with reduced mortality (OR 0.48; 95% CI: 0.25–0.94; P = 0.032). Conclusions This analysis demonstrates that primary malignancy type influences the likelihood of developing SC. Further studies will be necessary to delineate characteristics in patients with lung cancer and breast cancer which contribute to development of SC. Additional investigation should confirm lower mortality in patients with SC and breast cancer and determine possible explanations and protective factors.
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Affiliation(s)
- Awad I Javaid
- Division of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, 1701 W Charleston Blvd, Las Vegas, NV, USA
| | - Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,Center for Artificial Intelligence and Health Equities, Global System Analytics & Structures, New Orleans, LA, USA
| | - Gloria Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Phi Tran
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Alexandru Filipescu
- Department of Obstetrics and Gynecology, "Elias" Emergency University Hospital, Bucharest, Romania
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mohammad Madjid
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Konstantinos Charitakis
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Efstratios Koutroumpakis
- Division of Cardiology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
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Pacha HM, Sattar Y, Ahmad T, Dhoble A, Charitakis K, Arain S, Balan P, Johnson N, Alraies MC, Smalling R, Madjid M. PREDICTORS OF ACUTE MYOCARDIAL INFARCTION AND ADVERSE OUTCOMES IN PATIENTS HOSPITALIZED WITH INFLUENZA. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01560-6] [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: 11/30/2022]
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12
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Monlezun DJ, Lawless S, Palaskas N, Peerbhai S, Charitakis K, Marmagkiolis K, Lopez-Mattei J, Mamas M, Iliescu C. Machine Learning-Augmented Propensity Score Analysis of Percutaneous Coronary Intervention in Over 30 Million Cancer and Non-cancer Patients. Front Cardiovasc Med 2021; 8:620857. [PMID: 33889598 PMCID: PMC8055825 DOI: 10.3389/fcvm.2021.620857] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/15/2021] [Indexed: 12/17/2022] Open
Abstract
Background: It is unknown to what extent the clinical benefits of PCI outweigh the risks and costs in patients with vs. without cancer and within each cancer type. We performed the first known nationally representative propensity score analysis of PCI mortality and cost among all eligible adult inpatients by cancer and its types. Methods: This multicenter case-control study used machine learning–augmented propensity score–adjusted multivariable regression to assess the above outcomes and disparities using the 2016 nationally representative National Inpatient Sample. Results: Of the 30,195,722 hospitalized patients, 15.43% had a malignancy, 3.84% underwent an inpatient PCI (of whom 11.07% had cancer and 0.07% had metastases), and 2.19% died inpatient. In fully adjusted analyses, PCI vs. medical management significantly reduced mortality for patients overall (among all adult inpatients regardless of cancer status) and specifically for cancer patients (OR 0.82, 95% CI 0.75–0.89; p < 0.001), mainly driven by active vs. prior malignancy, head and neck and hematological malignancies. PCI also significantly reduced cancer patients' total hospitalization costs (beta USD$ −8,668.94, 95% CI −9,553.59 to −7,784.28; p < 0.001) independent of length of stay. There were no significant income or disparities among PCI subjects. Conclusions: Our study suggests among all eligible adult inpatients, PCI does not increase mortality or cost for cancer patients, while there may be particular benefit by cancer type. The presence or history of cancer should not preclude these patients from indicated cardiovascular care.
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Affiliation(s)
- Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Sean Lawless
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shareez Peerbhai
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Konstantinos Charitakis
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | | | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Department of Cardiology, Royal Stroke Hospital Stoke on Trent, Stoke-on-Trent, United Kingdom
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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Napierkowski S, Banerjee U, Anderson HV, Charitakis K, Madjid M, Smalling RW, Dhoble A. Trends and Impact of the Use of Mechanical Circulatory Support for Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy. Am J Cardiol 2021; 139:28-33. [PMID: 33035466 DOI: 10.1016/j.amjcard.2020.09.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 01/24/2023]
Abstract
Data on the trend and impact of mechanical circulatory support (MCS) in patients with Takotsubo cardiomyopathy (TC) are scarce. We evaluated the incidence and outcomes of cardiogenic shock (CS) in TC patients and the trend in use of MCS over time. The National Inpatient Sample from 2005 to 2014 was used to identify patients admitted with TC and those receiving MCS. Multivariate logistic regression was performed to identify predictors of mortality. The Cochran-Armitage test was used for the trend analysis across the years. Admissions for TC showed a linear increase for the study period. From 2005 to 2014 the proportion of TC managed with MCS remained stable, with some yearly fluctuations. Crude in-hospital mortality rate was 2.5% in the patients admitted with TC but was significantly higher in those with CS (15.81% vs 1.68%, p < 0.001). There was no difference in mortality in TC patients with CS, both with and without the use of MCS. However, patients managed with MCS were more likely to be discharged to a skilled nursing facility (31% vs 25.55, p = 0.015) compared with TC patients with CS who were medically managed. The cost of care for patients with TC and CS, managed with MCS was significantly higher than those managed medically ($171K vs $128K, p <0.001). In patients managed with MCS, only sepsis was associated with a higher likelihood of death using multivariate analysis (Odds Ratio 2.538, Confidence Interval 1.245 to 5.172; p = 0.011). In conclusion, the incidence of TC has increased over the years, but the proportion of patients requiring MCS has declined. Crude mortality rate for TC was 2.5%, but was 15.8% in the TC patients with CS. The use of MCS did not lead to improved mortality but was associated with higher cost and increased likelihood of skilled nursing facility discharge.
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Papadopoulos K, Charitakis K, Koustriava E, Kouroupetroglou G, Stylianidis E, Müller K, Sakalli Gumus S. Environmental information for inclusion in orientation and mobility maps, identified by travelers with blindness: The cases of city centers and neighborhoods/residential areas. British Journal of Visual Impairment 2020. [DOI: 10.1177/0264619620913895] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to investigate the user requirements of individuals with blindness regarding the information to be mapped on audio-tactile maps of city centers and neighborhoods/residential areas. Beyond that specific scope, this study aims at covering a wider research gap. That is, the investigation of the usefulness that individuals with blindness attribute to different spatial information (items) of differentiated environments: city centers and neighborhoods/residential areas. A total of 115 adults with blindness took part in the research. Participants came from four countries: Greece, Cyprus, Turkey, and Germany. The researchers listed 222 pieces of information concerning city centers and 226 pieces concerning neighborhoods/residential areas and address them in survey by conducting two respective questionnaires. Participants were asked to evaluate the information regarding the usefulness of the information with regard to safety, location of services, and orientation/wayfinding during movement. The result of the study is the definition of the most useful information that should be included in orientation and mobility (O&M) aids. Thus, the findings of this study will be particularly important for designers of O&M aids, O&M specialists, rehabilitation specialists, and teachers who design and construct O&M aids for their students with blindness.
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15
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Papadopoulos K, Charitakis K, Koustriava E, Kouroupetroglou G, Stiefelhagen R, Stylianidis E, Gumus SS. Environmental Information Required by Individuals with Visual Impairments Who Use Orientation and Mobility Aids to Navigate Campuses. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x20941312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: This study investigated the user requirements of individuals with visual impairments regarding the information to be included in orientation and mobility (O&M) aids in order for optimally useful audio-tactile maps of campuses to be developed. In addition, this study aimed at investigating the importance (usefulness) that individuals with visual impairments attribute to environmental information of campuses. Methods: The researchers listed 213 pieces of environmental information concerning campuses and address them in survey by conducting a respective questionnaire. Participants were asked to evaluate the information, regarding the importance or usefulness of the information in regard to safety, location of services, and orientation and wayfinding during movement. Through convenience sampling 115 adults (aged from 18 to 64 years) with visual impairments from four countries (Greece, Cyprus, Turkey, and Germany) took part in the research. Results: Pieces of environmental information, sorted in descending order starting with the most useful ones, have been listed. A repeated measures analysis of variance yielded a significant main effect for the type of information (safety, location of services, and wayfinding and orientation): F(2, 228) = 70.868, p < .001. Discussion: This study resulted in the specification of the most significant or useful information that should be included in O&M aids of campuses for individuals with visual impairments. Implications for practitioners: The results of this study will hold the interest of developers of O&M aids, O&M practitioners, rehabilitation teachers, and instructors who design and construct O&M aids. Moreover, the context for appropriately designed tactile or audio-tactile maps for campuses is provided, and campuses around the world could rely on this study for the creation of a valuable accessibility aid.
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Affiliation(s)
| | | | - Eleni Koustriava
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Georgios Kouroupetroglou
- Department of Informatics and Telecommunications, National and Kapodistrian University of Athens, Greece
| | - Rainer Stiefelhagen
- Study Center for the Visually Impaired (SZS), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Efstratios Stylianidis
- School of Spatial Planning and Development, Aristotle University of Thessaloniki, Greece
| | - Suad Sakalli Gumus
- Department of Education, Saint Mary-of-the-Woods College, Terre Haute, IN, USA
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Donisan T, Balanescu DV, Palaskas N, Lopez-Mattei J, Karimzad K, Kim P, Charitakis K, Cilingiroglu M, Marmagkiolis K, Iliescu C. Cardiac Interventional Procedures in Cardio-Oncology Patients. Cardiol Clin 2020; 37:469-486. [PMID: 31587788 DOI: 10.1016/j.ccl.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.
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Affiliation(s)
- Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/TDonisan
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/dinubalanescu
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Konstantinos Charitakis
- Department of Cardiology, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, Arkansas Heart Hospital, 1701 South Shackleford Road, Little Rock, AR 72211, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA.
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Agha AM, Gill C, Balanescu DV, Donisan T, Palaskas N, Lopez-Mattei J, Hassan S, Kim PY, Charitakis K, Cilingiroglu M, Oo TH, Kroll M, Durand JB, Hirsch-Ginsberg C, Marmagkiolis K, Iliescu C. Identifying Hemostatic Thresholds in Cancer Patients Undergoing Coronary Angiography Based on Platelet Count and Thromboelastography. Front Cardiovasc Med 2020; 7:9. [PMID: 32118047 PMCID: PMC7033624 DOI: 10.3389/fcvm.2020.00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the role of platelet count and thromboelastogram (TEG) in the treatment of thrombocytopenic cancer patients with suspected coronary artery disease (CAD). Background: Cancer patients with CAD and thrombocytopenia are often treated non-invasively (i.e., without coronary angiography when clinically indicated) due to perceived high risk of bleeding. We sought to evaluate coagulability based on TEG and determine if platelet count and TEG could predict bleeding risk/mortality among cancer patients undergoing coronary angiography (CA). Methods: Baseline demographics, platelet count, and TEG parameters were recorded among cancer patients that underwent CA and had a concomitant TEG. Logistic regression and univariate proportional hazards regression analysis were performed to determine the impact of platelet count and coagulability on 24-month overall survival (OS). Results: All patients with platelet count <20,000/mm3 and nearly all patients with platelet count 20,000–49,000/mm3 were hypocoagulable based on TEG results. In contrast, nearly all patients with platelet counts of 50,000–99,999/mm3 had normal TEG results and OS similar to those with platelet counts of ≥100,000/mm3. Coagulability based on TEG was not associated with OS. However, a platelet count of <50,000/mm3 was associated with worse 24-month OS (hazard ratio = 2.76; p = 0.0072) when compared with a platelet count of ≥100,000/mm3. No major bleeding complications were observed in all groups. Conclusion: The majority of cancer patients with platelet counts of <50,000/mm3 were hypocoagulable based on TEG and had worse OS at 24 months. The relatively normal TEGs in the >50,000/mm3 groups, as well as the improved survival, suggest that with appropriate clinical indication and risk/benefit assessment, a cut-off of 50,000/mm3 platelets can be considered for CA in cancer patients.
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Affiliation(s)
- Ali M Agha
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Clarence Gill
- Department of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Teodora Donisan
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Juan Lopez-Mattei
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Saamir Hassan
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Peter Y Kim
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | - Konstantinos Charitakis
- Department of Cardiology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, University of Arkansas, Little Rock, AR, United States
| | - Thein Hlaing Oo
- Department of Hematology, MD Anderson Cancer Center, Houston, TX, United States
| | - Michael Kroll
- Department of Hematology, MD Anderson Cancer Center, Houston, TX, United States
| | - Jean Bernard Durand
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Cezar Iliescu
- Department of Cardiology, MD Anderson Cancer Center, Houston, TX, United States
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Charitakis K, Schubert S, Hirshfeld JW. Mitral Leaflet Perforation: An Interventional Frontier for Nonsurgical Candidates? JACC Case Rep 2019; 1:694-695. [PMID: 34316911 PMCID: PMC8288578 DOI: 10.1016/j.jaccas.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, Texas
| | - Scott Schubert
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, Texas
| | - John W. Hirshfeld
- Cardiovascular Division, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Vejpongsa P, Kitkungvan D, Madjid M, Charitakis K, Anderson HV, Arain S, Balan P, Smalling RW, Dhoble A. Outcomes of Acute Myocardial Infarction in Patients with Influenza and Other Viral Respiratory Infections. Am J Med 2019; 132:1173-1181. [PMID: 31145880 DOI: 10.1016/j.amjmed.2019.05.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute influenza infection can trigger acute myocardial infarction, however, outcome of patients with acute myocardial infarction during influenza infection is largely unknown. METHODS Patients ≥18 years old with ST-elevation and non-ST-elevation myocardial infarction during January 2013-December 2014 were identified using the National Inpatient Sample. The clinical outcomes were compared among patients who had no respiratory infection to the ones with influenza and other viral respiratory infections using propensity score-matched analysis. RESULTS Of 1,884,985 admissions for acute myocardial infarction, acute influenza and other viral infections were diagnosed in 9,885 and 11,485 patients, respectively, accounting for 1.1% of patients. Acute myocardial infarction patients with concomitant influenza infection had a worse outcome than those with acute myocardial infarction alone, in terms of in-hospital case fatality rate, development of shock, acute respiratory failure, acute kidney injury, and higher rate of blood transfusion after propensity scores. The length of stay is also significantly longer in influenza patients with acute myocardial infarction, compared with patients with acute myocardial infarction alone. However, patients who developed acute myocardial infarction during other viral respiratory infection have a higher rate of acute respiratory failure but overall lower mortality rate, and are less likely to develop shock or require blood transfusion after propensity match. Despite presenting with acute myocardial infarction, less than one-fourth of patients with concomitant influenza infection underwent coronary angiography, but more than half (51.4%) required revascularization. CONCLUSION Influenza infection is associated with worse outcomes in acute myocardial infarction patients, and patients were less likely to receive further evaluation with invasive coronary angiography.
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Affiliation(s)
- Pimprapa Vejpongsa
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Danai Kitkungvan
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Mohammad Madjid
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Konstantinos Charitakis
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - H Vernon Anderson
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Salman Arain
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Prakash Balan
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Richard W Smalling
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston
| | - Abhijeet Dhoble
- University of Texas McGovern Medical School, Houston; Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston.
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Balan P, Hsi B, Thangam M, Zhao Y, Monlezun D, Arain S, Charitakis K, Dhoble A, Johnson N, Anderson HV, Persse D, Warner M, Ostermayer D, Prater S, Wang H, Doshi P. The cardiac arrest survival score: A predictive algorithm for in-hospital mortality after out-of-hospital cardiac arrest. Resuscitation 2019; 144:46-53. [PMID: 31539610 DOI: 10.1016/j.resuscitation.2019.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 04/21/2019] [Revised: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Current methods for predicting mortality post-arrest require data unavailable at the time of initial medical contact. We created and validated a risk prediction model for patients experiencing OHCA who achieved return of spontaneous circulation (ROSC) which relies only on objective information routinely obtained at first medical contact. METHODS We performed a retrospective evaluation of 14,892 OHCA patients in a large metropolitan cardiac arrest registry, of which 3952 patients had usable data. This population was divided into a derivation cohort (n = 2,635) and a verification cohort (n = 1,317) in a 2:1 ratio. Backward stepwise logistic regression was used to identify baseline factors independently associated with death after sustained ROSC in the derivation cohort. The cardiac arrest survival score (CASS) was created from the model and its association with in-hospital mortality was examined in both the derivation and verification cohorts. RESULTS Baseline characteristics of the derivation and verification cohorts were not different. The final CASS model included age >75 years (odds ratio [OR] = 1.61, confidence interval [CI][1.30-1.99], p < 0.001), unwitnessed arrest (OR = 1.95, CI[1.58-2.40], p < 0.001), home arrest (OR = 1.28, CI[1.07-1.53], p = 0.008), absence of bystander CPR (OR = 1.35, CI[1.12-1.64], p = 0.003), and non-shockable initial rhythm (OR = 3.81, CI[3.19-4.56], p < 0.001). The area under the curve for the model derivation and model verification cohorts were 0.7172 and 0.7081, respectively. CONCLUSION CASS accurately predicts mortality in OHCA patients. The model uses only binary, objective clinical data routinely obtained at first medical contact. Early risk stratification may allow identification of more patients in whom timely and aggressive invasive management may improve outcomes.
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Affiliation(s)
- Prakash Balan
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States.
| | - Brian Hsi
- Department of Internal Medicine, Division of Cardiology Houston Methodist Hospital, Weill Cornell Medical College, United States
| | - Manoj Thangam
- Department of Internal Medicine, Division of Cardiovascular Medicine Washington University School of Medicine St. Louis, United States
| | - Yelin Zhao
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Dominique Monlezun
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Salman Arain
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Abhijeet Dhoble
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Nils Johnson
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - H Vernon Anderson
- Department of Internal Medicine, Division of Cardiology McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - David Persse
- Physician Director of Emergency Medical Services City of Houston, United States
| | - Mark Warner
- Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Daniel Ostermayer
- Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Samuel Prater
- Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Henry Wang
- Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
| | - Pratik Doshi
- Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States; Department of Emergency Medicine McGovern Medical School at The University of Texas Health Science Center Houston, United States
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21
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Abstract
See Article by Akodad et al
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Affiliation(s)
- Konstantinos Charitakis
- 1 Division of Cardiology Department of Internal Medicine University of Texas Health Science Center, Houston McGovern Medical School Houston TX
| | - Tom C Nguyen
- 2 Department of Cardiothoracic and Vascular Surgery University of Texas Health Science Center, Houston McGovern Medical School Houston TX
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Vejpongsa P, Kitkungvan D, Madjid M, Charitakis K, Anderson HV, Arain S, Balan P, Smalling R, Dhoble A. OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH INFLUENZA & OTHER VIRAL RESPIRATORY INFECTIONS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33767-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Kim LK, Yeo I, Cheung JW, Swaminathan RV, Wong SC, Charitakis K, Adejumo O, Chae J, Minutello RM, Bergman G, Singh H, Feldman DN. Thirty-Day Readmission Rates, Timing, Causes, and Costs after ST-Segment-Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010-2014. J Am Heart Assoc 2018; 7:e009863. [PMID: 30371187 PMCID: PMC6222940 DOI: 10.1161/jaha.118.009863] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
Abstract
Background Readmission after ST-segment-elevation myocardial infarction ( STEMI ) poses an enormous economic burden to the US healthcare system. Efforts to prevent readmissions should be based on understanding the timing and causes of these readmissions. This study aimed to investigate contemporary causes, timing, and cost of 30-day readmissions after STEMI . Methods and Results All STEMI hospitalizations were selected in the Nationwide Readmissions Database ( NRD ) from 2010 to 2014. The 30-day readmission rate as well as the primary cause and cost of readmission were examined. Multivariate regression analysis was performed to identify the predictors of 30-day readmission and increased cumulative cost. From 2010 to 2014, the 30-day readmission rate after STEMI was 12.3%. Within 7 days of discharge, 43.9% were readmitted, and 67.3% were readmitted within 14 days. The annual rate of 30-day readmission decreased by 19% from 2010 to 2014 ( P<0.001). Female sex, AIDS , anemia, chronic kidney disease , collagen vascular disease, diabetes mellitus, hypertension, pulmonary hypertension, congestive heart failure , atrial fibrillation, and increased length of stay were independent predictors of 30-day readmission. A large proportion of patients (41.6%) were readmitted for noncardiac reasons. After multivariate adjustment, 30-day readmission was associated with a 47.9% increase in cumulative cost ( P<0.001). Conclusions Two thirds of patients were readmitted within the first 14 days after STEMI , and a large proportion of patients were readmitted for noncardiac reasons. Thirty-day readmission was associated with an ≈50% increase in cumulative hospitalization costs. These findings highlight the importance of closer surveillance of both cardiac and general medical conditions in the first several weeks after STEMI discharge.
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Affiliation(s)
- Luke K. Kim
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Ilhwan Yeo
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Jim W. Cheung
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | | | - S. Chiu Wong
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Konstantinos Charitakis
- Department of CardiologyMcGovern Medical SchoolUniversity of Texas Health Science CenterHoustonTX
| | - Oluwayemisi Adejumo
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - John Chae
- Weill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Robert M. Minutello
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Geoffrey Bergman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Harsimran Singh
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
| | - Dmitriy N. Feldman
- Weill Cornell Cardiovascular Outcomes Research Group (CORG)Division of CardiologyDepartment of MedicineWeill Cornell Medical CollegeNew York Presbyterian HospitalNew YorkNY
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Munoz E, Iliescu G, Vejpongsa P, Charitakis K, Karimzad K, Lopez-Mattei J, Yusuf SW, Marmagkiolis K, Iliescu C. Takotsubo Stress Cardiomyopathy: "Good News" in Cancer Patients? J Am Coll Cardiol 2018; 68:1143-4. [PMID: 27585514 DOI: 10.1016/j.jacc.2016.06.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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Marmagkiolis K, Hakeem A, Cilingiroglu M, Feldman DN, Charitakis K. Efficacy and safety of routine aspiration thrombectomy during primary PCI for ST-segment elevation myocardial infarction: A meta-analysis of large randomized controlled trials. Hellenic J Cardiol 2018; 59:168-173. [DOI: 10.1016/j.hjc.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/25/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022] Open
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Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) has become an established therapy for patients with symptomatic severe aortic stenosis (AS). As the number of patients referred for TAVR increases, so does the prevalence of untreated obstructive coronary artery disease (CAD) in the population under evaluation. Despite the high prevalence of CAD in patients treated with TAVR, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty. RECENT FINDINGS Percutaneous coronary intervention (PCI) in patients with CAD and severe AS has been shown to be feasible and safe. Whether revascularization before, during, or after TAVR is optimal remains a subject of debate. All three approaches represent valid strategies with advantages and disadvantages that need to be carefully weighed on an individual basis. Current expert opinions recommend that PCI should be performed before or at the time of TAVR as long as the risk of the procedure does not outweigh the potential benefits. The results of large clinical trials evaluating the optimal revascularization time are closely awaited.
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Affiliation(s)
- Konstantinos V Voudris
- Department of Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Chicago, IL, USA.
- Department of Medicine, Advocate Christ Medical Center, 4440 W 95th Street, Suite 131 NOB, Oak Lawn, IL, 60453, USA.
| | - Peter Petropulos
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Konstantinos Charitakis
- Department of Cardiology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Jacob R, Vejpongsa P, Poosti K, Bhise V, Zhao Y, Arain S, Balan P, Charitakis K, Madjid M, Johnson N, Anderson HV, Smalling R, Dhoble A. EARLY READMISSIONS AFTER REVASCULARIZATION IN PATIENTS PRESENTING WITH NON-ST ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31853-9] [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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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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Thangam M, Hsi B, Zhao Y, Warner M, Arain S, Charitakis K, Dhoble A, Johnson N, Smalling R, Anderson H, Doshi P, Balan P. TCT-493 Cardiac Arrest Survival Score: A Novel Tool for Predicting Mortality Post Cardiac Arrest. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.605] [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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Voudris K, Feldman D, Minutello R, Kim L, Charitakis K, Singh H, Bergman G, Salemi A, Wong SC. TCT-439 Trans-Apical Aortic Valve Replacement in Patients with History of Coronary Artery Bypass Grafting Surgery: An Analysis of the National Inpatient Sample Database. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.545] [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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31
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Nguyen TC, Charitakis K. Wearing a full metal jacket should not be en vogue. J Thorac Cardiovasc Surg 2017; 155:227-228. [PMID: 28947194 DOI: 10.1016/j.jtcvs.2017.08.072] [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: 08/14/2017] [Accepted: 08/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Tom C Nguyen
- Department of Cardiothoracic Surgery, University of Texas Houston-Memorial Hermann, Houston, Tex.
| | - Konstantinos Charitakis
- Department of Cardiothoracic Surgery, University of Texas Houston-Memorial Hermann, Houston, Tex
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Nguyen TC, Charitakis K. Fractional flow reserve-guided coronary artery bypass grafting: Less is more? J Thorac Cardiovasc Surg 2017; 154:1576-1577. [PMID: 28781088 DOI: 10.1016/j.jtcvs.2017.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/12/2017] [Accepted: 06/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tom C Nguyen
- Department of Cardiothoracic Surgery, University of Texas Houston, Houston, Tex.
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Vejpongsa P, Bhise V, Charitakis K, Vernon Anderson H, Balan P, Nguyen TC, Estrera AL, Smalling RW, Dhoble A. Early readmissions after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv 2017; 90:662-670. [DOI: 10.1002/ccd.26945] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/28/2016] [Accepted: 12/30/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Pimprapa Vejpongsa
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Viraj Bhise
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Department of management policy and community health, School of Public Health; University of Texas; Houston Texas
| | - Konstantinos Charitakis
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - H. Vernon Anderson
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Prakash Balan
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Tom C. Nguyen
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Anthony L. Estrera
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Richard W. Smalling
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
| | - Abhijeet Dhoble
- Department of Cardiology, University of Texas McGovern School of Medicine; Houston Texas
- Memorial Herman Heart and Vascular Center, Texas Medical Center; Houston Texas
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Marmagkiolis K, Mustapha J, Montero-Baker M, Charitakis K, Iliescu C, Feldman D, Cilingiroglu M. SAFETY AND EFFICACY OF TRANSPEDAL ACCESS FOR THE MANAGEMENT OF COMPLEX PERIPHERAL ARTERIAL DISEASE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34393-0] [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: 11/17/2022]
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Marmagkiolis K, Iliescu C, Charitakis K, Cilingiroglu M. 3-MONTH AND 6-MONTH PRIMARY PATENCY WITH STENT VERSUS BALLOON ANGIOPLASTY FOR FAILING ARTERIOVENOUS GRAFTS FAILURE: A META-ANALYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35445-1] [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: 11/17/2022]
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Abstract
Acute kidney injury (AKI) is relatively common in patients undergoing transcatheter aortic valve implantation (TAVI) and has been associated with increased mortality and worse outcomes. The administration of iodinated contrast media in an elderly population with increased rates of chronic kidney injury and heart failure, the risk of hemodynamic compromise and the use of large catheters intra-procedurally make patients undergoing TAVI particularly vulnerable to renal insults and AKI. Furthermore, these patients are commonly exposed to iodinated contrast media during diagnostic and possible interventional procedures pre-TAVI. While risk factors such as baseline comorbidities are non-modifiable, others such as administration of nephrotoxic medications, the type and amount of contrast medium and the catheters size can be avoided, modified and improved. In addition, numerous other interventions such as volume expansion and possibly medications can prevent contrast related kidney injury. In this review, we sought to focus on strategies aiming at reducing the incidence of TAVI-related AKI.
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Affiliation(s)
| | | | - Konstantinos Charitakis
- University of Texas Medical School in Houston 6431 Fannin Street MSB 1.248 Houston, 77005, TX.
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Dhoble A, Bhise V, Charitakis K, Balan P, Arain S, Nguyen TC, Smalling R. TCT-668 Comparison of Early Readmissions after Transcatheter and Surgical Aortic Valve Replacement. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.081] [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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Moustafa GA, Kolokythas A, Charitakis K, Avgerinos DV. Therapeutic Utilities of Pediatric Cardiac Catheterization. Curr Cardiol Rev 2016; 12:258-269. [PMID: 26926291 PMCID: PMC5304250 DOI: 10.2174/1573403x12666160301121253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/17/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
In an era when less invasive techniques are favored, therapeutic cardiac catheterization constantly evolves and widens its spectrum of usage in the pediatric population. The advent of sophisticated devices and well-designed equipment has made the management of many congenital cardiac lesions more efficient and safer, while providing more comfort to the patient. Nowadays, a large variety of heart diseases are managed with transcatheter techniques, such as patent foramen ovale, atrial and ventricular septal defects, valve stenosis, patent ductus arteriosus, aortic coarctation, pulmonary artery and vein stenosis and arteriovenous malformations. Moreover, hybrid procedures and catheter ablation have opened new paths in the treatment of complex cardiac lesions and arrhythmias, respectively. In this article, the main therapeutic utilities of cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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Abstract
Although the utility of diagnostic cardiac catheterization in the clinical setting has diminished over the last years, due to the emergence of noninvasive imaging modalities, such as echocardiography, magnetic resonance imaging and computed tomography, catheterization for diagnostic reasons still constitutes a valuable tool in certain parts in the workup of pediatric heart disease. As a result, awareness of the main aspects of diagnostic catheterization is of great importance for the clinical cardiologist. In this article, the main variables measured and the main actions performed during diagnostic cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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Herrmann J, Yang EH, Iliescu CA, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas K, Leesar MA, Grines CL, Marmagkiolis K. Vascular Toxicities of Cancer Therapies: The Old and the New--An Evolving Avenue. Circulation 2016; 133:1272-89. [PMID: 27022039 DOI: 10.1161/circulationaha.115.018347] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [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] [Indexed: 01/17/2023]
Abstract
Since the late 1990s, there has been a steady decline in cancer-related mortality, in part related to the introduction of so-called targeted therapies. Intended to interfere with a specific molecular pathway, these therapies have, paradoxically, led to a number of effects off their intended cancer tissue or molecular targets. The latest examples are tyrosine kinase inhibitors targeting the Philadelphia Chromosome mutation product, which have been associated with progressive atherosclerosis and acute vascular events. In addition, agents designed to interfere with the vascular growth factor signaling pathway have vascular side effects ranging from hypertension to arterial events and cardiomyocyte toxicity. Interestingly, the risk of cardiotoxicity with drugs such as trastuzumab is predicted by preexisting cardiovascular risk factors and disease, posing the question of a vascular component to the pathophysiology. The effect on the coronary circulation has been the leading explanation for the cardiotoxicity of 5-fluorouracil and may be the underlying the mechanism of presentation of apical ballooning syndrome with various chemotherapeutic agents. Classical chemotherapeutic agents such as cisplatin, often used in combination with bleomycin and vinca alkaloids, can lead to vascular events including acute coronary thrombosis and may be associated with an increased long-term cardiovascular risk. This review is intended to provide an update on the evolving spectrum of vascular toxicities with cancer therapeutics, particularly as they pertain to clinical practice, and to the conceptualization of cardiovascular diseases, as well. Vascular toxicity with cancer therapy: the old and the new, an evolving avenue.
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Affiliation(s)
- Joerg Herrmann
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.).
| | - Eric H Yang
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Cezar A Iliescu
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Mehmet Cilingiroglu
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Konstantinos Charitakis
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Abdul Hakeem
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Konstantinos Toutouzas
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Massoud A Leesar
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Cindy L Grines
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
| | - Konstantinos Marmagkiolis
- From Mayo Clinic, Division of Cardiovascular Diseases, Rochester, MN (J.H.); University of California at Los Angeles, Division of Cardiology, Los Angeles (E.-H.Y.); University of Texas, MD Anderson Cancer Center, Houston (C.A.I.); Arkansas Heart Hospital, Little Rock, AR and Koc University School of Medicine, Istanbul, Turkey (M.C.); University of Texas Health Science Center, Houston (K.C.); University of Arkansas for Medical Sciences, Little Rock (A.H.); Athens Medical School, Hippokration General Hospital, Greece (K.T.); University of Alabama at Birmingham (M.A.L.); Detroit Medical Center, Cardiovascular Institute, MI (C.L.G.); and Citizens Memorial Hospital, Bolivar, MO and University of Missouri, Columbia (K.M.)
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Kim LK, Swaminathan RV, Looser P, Minutello RM, Wong SC, Bergman G, Naidu SS, Gade CLF, Charitakis K, Singh HS, Feldman DN. Hospital Volume Outcomes After Septal Myectomy and Alcohol Septal Ablation for Treatment of Obstructive Hypertrophic Cardiomyopathy. JAMA Cardiol 2016; 1:324-32. [DOI: 10.1001/jamacardio.2016.0252] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [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: 11/14/2022]
Affiliation(s)
- Luke K. Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Rajesh V. Swaminathan
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Patrick Looser
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Robert M. Minutello
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - S. Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Geoffrey Bergman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Srihari S. Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Christopher L. F. Gade
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Konstantinos Charitakis
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Harsimran S. Singh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Dmitriy N. Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York
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Wayangankar SA, Bangalore S, McCoy LA, Jneid H, Latif F, Karrowni W, Charitakis K, Feldman DN, Dakik HA, Mauri L, Peterson ED, Messenger J, Roe M, Mukherjee D, Klein A. Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry. JACC Cardiovasc Interv 2016; 9:341-351. [PMID: 26803418 DOI: 10.1016/j.jcin.2015.10.039] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/17/2015] [Accepted: 10/24/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who underwent percutaneous coronary intervention (PCI) from the Cath-PCI Registry (2005 to 2013). BACKGROUND The authors examined contemporary use and outcomes of PCI in patients with CS-AMI. METHODS The authors used the Cath-PCI Registry to evaluate 56,497 patients (January 2005 to December 2013) undergoing PCI for CS-AMI. Temporal trends in clinical variables and outcomes were assessed. RESULTS Compared with cases performed from 2005 to 2006, CS-AMI patients receiving PCI from 2011 to 2013 were more likely to have diabetes, hypertension, dyslipidemia, previous PCI, dialysis, but less likely to have chronic lung disease, peripheral vascular disease, or heart failure within 2 weeks (p < 0.01). Between 2005 and 2006 to 2011 and 2013, intra-aortic balloon pump use decreased (49.5% to 44.9%; p < 0.01), drug-eluting stent use declined (65% to 46%; p < 0.01), and the use of bivalirudin increased (12.6% to 45.6%). Adjusted in-hospital mortality; increased (27.6% in 2005 to 2006 vs. 30.6% in 2011 to 2013, adjusted odds ratio: 1.09, 95% confidence interval: 1.005 to .173; p = 0.04) for patients who were managed with an early invasive strategy (<24 h from symptoms). CONCLUSIONS Our study shows that despite the evolution of medical technology and use of contemporary therapeutic measures, in-hospital mortality in CS-AMI patients who are managed invasively continues to rise. Additional research and targeted efforts are indicated to improve outcomes in this high-risk cohort.
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Affiliation(s)
| | | | - Lisa A McCoy
- Duke Clinical Research Institute, Durham, North Carolina
| | - Hani Jneid
- Baylor College of Medicine, Houston, Texas
| | - Faisal Latif
- Health Sciences Center and Veterans Affairs Medical Center, University of Oklahoma, Oklahoma City, Oklahoma
| | | | | | - Dmitriy N Feldman
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | | | - Laura Mauri
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - John Messenger
- School of Medicine, University of Colorado, Denver, Colorado
| | - Mathew Roe
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Andrew Klein
- St. Louis VA Medical Center, and Department of Internal Medicine, School of Medicine, Saint Louis University, Saint Louis, Missouri
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Abstract
OPINION STATEMENT ST-segment elevation myocardial infarction (STEMI) remains an important cause of morbidity and mortality. In the USA, the development of an organized STEMI network has allowed STEMI patients greater access to primary PCI. The most important goal in the management of STEMI is timely reperfusion and establishment of normal coronary flow. However, periprocedural thrombus embolization, which can obstruct the distal microvasculature and impair tissue perfusion, is associated with unfavorable outcomes. Over the last years, aspiration thrombectomy has emerged as a novel technique to prevent distal coronary thromboembolism during primary PCI. The initial excitement after the publication of the TAPAS trial changed the practice paradigm among interventional community worldwide. Aspiration thrombectomy was recommended by several society guidelines and became the "standard of care" during primary PCI. However, recent data and publication of two large randomized controlled trials questioned the effectiveness (TASTE trial) and the safety (TOTAL trial) of this technique. Therefore, the recent ACC/AHA/SCAI-focused update document recommended against the routine use of manual thrombectomy during primary PCI. This review will summarize recent data and trials regarding thrombus aspiration in STEMI.
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Affiliation(s)
- Konstantinos Marmagkiolis
- Citizens Memorial Hospital, 1500 N Oakland Rd, Bolivar, MO, 65613, USA.
- University of Missouri, Columbia, MO, USA.
| | - Dmitriy N Feldman
- Division of Cardiology,Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
| | - Konstantinos Charitakis
- University of Texas Health Science Center at Houston, Texas Medical Center, 6431 Fannin Street, Houston, TX, 77030, USA.
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Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [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: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
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Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
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Iliescu C, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas K, Leesar MA, Marmagkiolis K. SCAI expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (Endorsed by the Cardiological Society of India, and Sociedad Latino Americana de Cardiologıa Interve. Catheter Cardiovasc Interv 2015; 87:895-9. [DOI: 10.1002/ccd.26375] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [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: 11/09/2015] [Accepted: 11/28/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Cezar Iliescu
- University of Texas, MD Anderson Cancer Center; Houston Texas
| | - Cindy L. Grines
- Detroit Medical Center, Cardiovascular Institute; Detroit Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Eric H. Yang
- Division of Cardiology; University of California at Los Angeles; Los Angeles California
| | - Mehmet Cilingiroglu
- School of Medicine; Arkansas Heart Hospital; Little Rock Arkansas
- Koc University; Istanbul Turkey
| | | | - Abdul Hakeem
- University of Arkansas for Medical Sciences; Little Rock Arkansas
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Chanin JM, Yang DC, Haider MA, Swaminathan RV, Kim LK, Charitakis K, Tanoue M, Minutello RM, Gade CL, Singh HS, Bergman G, Wong SC, Feldman DN. Impact of Chronic Statin Therapy on Postprocedural Contrast-Induced Nephropathy in Patients Undergoing Non-Emergent Percutaneous Coronary Intervention. J Invasive Cardiol 2015; 27:490-496. [PMID: 25999136] [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: 06/04/2023]
Abstract
BACKGROUND Following percutaneous coronary intervention (PCI), elevations in serum creatinine level and declines in glomerular filtration rate are common. Prior studies have demonstrated benefit of chronic statin therapy in the prevention of contrast-induced nephropathy (CIN); however, it is unknown whether chronic statin therapy reduces the incidence of CIN in the non-emergent PCI setting. METHODS Using the 2004-2005 Cornell Angioplasty Registry, a total of 1171 consecutive patients were selected for analysis. The population was divided into two groups: (1) patients on chronic (≥30 days) statin therapy prior to PCI (n = 874); and (2) patients not on chronic statin therapy (n = 297). RESULTS Patients taking chronic statin therapy were more likely to have diabetes mellitus (35.7% vs 22.6%; P<.001), previous myocardial infarction (36.3% vs 20.5%; P<.001), previous PCI (38.9% vs 16.2%; P<.001), and previous coronary artery bypass graft surgery (19.5% vs 11.4%; P=.01). Statin users were also more likely to be taking long-term aspirin (77.8% vs 59.6%; P<.001) and clopidogrel therapy (29.9% vs 14.1%; P<.001). Baseline serum creatinine levels were comparable between the two groups, as were procedural characteristics. The incidence of CIN following PCI was not significantly different between patients on chronic statin therapy versus those not on chronic statin therapy (4.2% vs 5.4%; P=.42). However, after multivariate adjustment, chronic statin therapy was associated with a lower incidence of CIN (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.05-0.94; P=.04). Acute heart failure on admission and the urgency of the procedure (urgent vs elective PCI) were also independent predictors for developing CIN (OR, 3.04; 95% CI, 1.45-6.66 [P=.01] and OR, 2.80; 95% CI, 1.42-5.55 [P=.01], respectively). Long-term mortality rates were similar between those on chronic statin therapy and those not on statins. CONCLUSION CIN occurred in 4.5% of patients following non-emergent PCI. Multivariate analysis demonstrated that chronic statin therapy decreased the odds of developing CIN in patients undergoing PCI.
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Affiliation(s)
- Jake M Chanin
- New York Presbyterian Hospital, Weill Cornell Medical College, Greenberg Division of Cardiology, 520 East 70th Street, Starr-434 Pavilion, New York, NY 10021 USA.
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Kim LK, Swaminathan RV, Minutello RM, Gade CL, Yang DC, Charitakis K, Shah A, Kaple R, Bergman G, Singh H, Wong SC, Feldman DN. Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007-2011. Catheter Cardiovasc Interv 2015; 86:864-72. [PMID: 26446891 DOI: 10.1002/ccd.26065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 10/15/2014] [Accepted: 05/19/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study sought to identify the temporal trends of presenting diagnoses and vascular procedures performed for peripheral arterial disease (PAD) along with the rates of procedures and in-hospital outcomes by payer status. BACKGROUND Previous studies suggest that patients with Medicare, Medicaid, or lack of insurance receive poorer quality of care leading to worse outcomes. METHODS We analyzed 196,461,055 discharge records to identify all hospitalized patients with PAD records (n=1,687,724) from January 2007 through December 2011 in the Nationwide Inpatient Sample database. RESULTS The annual frequency of vascular procedures remained unchanged during the study period. Patients with Medicaid were more likely to present with gangrenes, whereas patients with Medicare were more likely to present with ulcers. After adjustment, patients with Medicare and Medicaid were more likely to undergo amputations when compared with private insurance/HMO (OR=1.13, 95% CI=1.10-1.16 and OR=1.24, 95% CI=1.20-1.29, respectively). Patients with both Medicare and Medicaid were less likely to undergo bypass surgery (OR=0.82, 95% CI=0.81-0.84 and OR=0.87, 95% CI=0.85-0.90, respectively), but more likely to undergo endovascular procedures (OR=1.18, 95% CI=1.17-1.20 and OR=1.03, 95% CI=1.01-1.06, respectively). Medicare and Medicaid status versus private insurance/HMO was associated with worse adjusted odds of in-hospital outcomes, including mortality after amputations, endovascular procedures, and bypass surgeries. CONCLUSIONS In this analysis, patients with Medicare and Medicaid had more comorbid conditions at baseline when compared with private insurance/HMO cohorts, were more likely to present with advanced stages of PAD, undergo amputations, and develop in-hospital complications. These data unveil a critical gap and an opportunity for quality improvement in the elderly and those with poor socioeconomic status.
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Affiliation(s)
- Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Rajesh V Swaminathan
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Christopher L Gade
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - David C Yang
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Konstantinos Charitakis
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Ashish Shah
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Ryan Kaple
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Geoffrey Bergman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Harsimran Singh
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Voudris K, Chanin J, Feldman D, Charitakis K. Novel Inflammatory Biomarkers in Coronary Artery Disease: Potential Therapeutic Approaches. Curr Med Chem 2015; 22:2680-9. [DOI: 10.2174/0929867322666150420124427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 01/27/2015] [Accepted: 04/16/2015] [Indexed: 11/22/2022]
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49
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Avgerinos DV, Charitakis K. Hybrid coronary revascularization: present and future. Hellenic J Cardiol 2015; 56:193-196. [PMID: 26021239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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50
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Voudris K, Avgerinos DV, Feldman D, Charitakis K. Hybrid Coronary Revascularization: Present Indications and Future Perspective. Curr Treat Options Cardio Med 2015; 17:364. [DOI: 10.1007/s11936-015-0364-3] [Citation(s) in RCA: 3] [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: 10/24/2022]
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