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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Mohamed M, Banerjee A, Clarke S, De Belder M, Goodwin A, Gale C, Curzen N, Mamas M. Impact of COVID-19 on cardiac procedure activity in England and associated 30-day mortality. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic had a significant impact on the quality of healthcare provision across all specialities and disciplines. However, there are limited data on the scale of its disruption to cardiac procedure activity from a national perspective and whether procedural outcomes different before and during the COVID-19 pandemic.
Methods
Major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression modelling was undertaken to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period (vs. pre-COVID).
Results
There was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018–2019. Cardiac catheterisation and cardiac electronic device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) while surgical procedures including mitral valve replacement, other valve replacement/repair, atrial and ventricular septal defect repair, and CABG were the most affected as a relative percentage difference (D) to previous years' averages. TAVR was the least affected (D-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07–1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15–1.58, p<0.001).
Conclusion
There was a significant decline in national cardiac procedural activity in England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures over the study period. However, there was no increase in risk of mortality for most cardiac procedures performed during the pandemic. While health service pressures are gradually easing given the increased roll out of vaccination and decline in infection rates, there is a need for major restructuring of cardiac services deal with this significant backlog of procedures, which would inevitably impact longer-term morbidity and mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mohamed
- Keele University , Keele , United Kingdom
| | - A Banerjee
- University College London , London , United Kingdom
| | - S Clarke
- Royal Papworth Hospital NHS Foundation Trust , Cambridge , United Kingdom
| | - M De Belder
- National Institute for Cardiovascular Outcomes Research , London , United Kingdom
| | - A Goodwin
- National Institute for Cardiovascular Outcomes Research , London , United Kingdom
| | - C Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, Cardiology , Leeds , United Kingdom
| | - N Curzen
- University of Southampton, Cardiology , Southampton , United Kingdom
| | - M Mamas
- Keele University , Keele , United Kingdom
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Ahsan M, Taskesen T, Putz J, Ugwu J, Latif A, Park A, De Santis T, Sigurdsson G, Shivapour D, McAllister D, Chawla A, Bhatt D, Mamas M, Velagapudi P, Martin E. Sex-based differences of the impact of aortic valve calcium score on mortality and post-procedural outcomes after trans-catheter aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sex based differences exist in the presentation, outcomes, and management of cardiovascular diseases. Although aortic valve calcium (AVC) score has been postulated to be associated with post-procedural outcomes after transcatheter aortic valve replacement (TAVR), data on the impact of AVC score on procedural outcomes after TAVR based on sex have been scarce.
Objective
The aim of the present study was to elucidate sex related differences in the prognostic impact of AVC score as a predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.
Methods
We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was calculated retrospectively. Primary outcome was 1-year mortality. Patients were divided into two groups: 1) Non-severe AVC score group [women <1200 Agatston unit (AU) and men <2000 AU]; 2) Severe AVC Score group [women >1200 AU and men >2000 AU]. Cox-regression model was used to predict effect of variables on 1-year mortality in male and female patients.
Results
Among 466 patients included, 268 patients were male and 198 were female (57.5% vs 42.5%). When compared with males, female patients had significantly lower AVC score (p<0.001), aortic valve area (AVA) (p<0.001), obstructive CAD (p<0.001), and history of previous PCI (p<0.004), and CABG (<0.001) but had a significantly higher STS score (6.7±3.2 vs 5.8±3.3 P=0.01). There was no difference between need for permanent pacemaker (PPM) implantation (11% vs 9.6%, p=0.4), major complications (16% vs 15%, p=0.9), stroke (0.8% vs 1.6%, p=0.7), 30-day (3.7% vs 4%, p=0.9), and 1-year mortality (14% vs 12%, p=0.6) between males and females, respectively. Female patients required smaller bio-prosthetic valves compared with males (26±3.2 vs 30±3, p<0.001). Cox regression analysis for female patients showed BMI, hemoglobin level, and AVA independently predicted 1-year mortality, while there was no impact of severe AVC score (>1200 AU) on 1-year mortality in females. Similarly, Cox regression analysis for male patients showed there was no impact of severe AVC score (>2000 AU) on 1-year mortality in males. When males in the severe AVC group were compared with female patients in the severe AVC group, there was no difference in 30 day (4.3% vs 3.3%, p=0.82) and 1-year mortality (14.2% vs 13.3%, p=0.77). Similarly, in the severe AVC group there was no difference between need for PPM implantation (12.8% vs 12.1%, p=0.9), major complications (19.7% vs 15.8%, p=0.4), and stroke (2.2% vs 1%, p=0.6) between males and females, respectively.
Conclusion
There were no sex differences in the impact of AVC score on mortality and post-procedural outcomes after TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ahsan
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - T Taskesen
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - J Putz
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - J Ugwu
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - A Latif
- Creighton University Medical Centre, Internal Medicine , Omaha , United States of America
| | - A Park
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - T De Santis
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - G Sigurdsson
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D Shivapour
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D McAllister
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - A Chawla
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center, Cardiovascular Diseases , Boston , United States of America
| | - M Mamas
- Keele University, Cardiovascular Diseases , Keele , United Kingdom
| | - P Velagapudi
- University of Nebraska Medical Center, Cardiovascular Diseases , Omaha , United States of America
| | - E Martin
- Iowa Heart Center Inc , West Des Moines , United States of America
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Dhaliwal A, Kaur A, Konje S, Bhatia K, Sohal S, Rawal H, Turagam M, Gwon Y, Mamas M, Dominguez A, Bhatt D, Velagapudi P. Comparing direct oral anticoagulants versus vitamin K antagonist in patients with atrial fibrillation after transcatheter aortic valve replacement: an updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Oral anticoagulation therapy is indicated for patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant or new onset atrial fibrillation (AF). However the data on optimal anticoagulation regimen in this population remains unclear.
Purpose
To compare efficacy and safety outcomes of direct oral anticoagulants (DOACs) versus Vitamin K antagonists (VKA) in patients with AF post TAVR.
Methods
We searched electronic databases (PubMed, Embase, Scopus, Cochrane) from inception to February28th, 2022 using MeSH terms and keywords for DOACs, AF or TAVR. Primary outcome of interest was all-cause stroke or systemic embolic event. Secondary safety outcomes were major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effects model. Interstudy heterogeneity was assessed using the Higgins I 2 value. All statistical analysis were performed using RevMan 5.4.1 software.
Results
We identified five eligible studies (1RCT, 4 observational) including 3694 patients (DOAC n=1581, VKA n=2113). The mean age was 81.4±0.9 years. The mean follow-up was 12.4±14.3 months. Type of DOACs included apixaban (n=394, 24.9%), rivaroxaban (n=354, 22.4%), dabigatran (n=119, 7.5%) and edoxaban (n=714, 45.2%).There was no significant difference in primary outcome of stroke or systemic embolic event (RR: 0.93; CI: 0.65–1.33; p>0.05; I2=5%), or in secondary outcomes of major bleeding (RR: 1.02; CI: 0.78–1.34; p>0.05; I2=44%) and all-cause mortality (RR: 0.87; CI: 0.59–1.27; p>0.05; I2=56%) between DOACs and VKA groups.
Conclusion
This meta-analysis shows anticoagulation therapy with DOACs has similar safety and efficacy outcomes compared to VKA in patients with AF undergoing TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Dhaliwal
- New York Hand Surgery , New York , United States of America
| | - A Kaur
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - S Konje
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - K Bhatia
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - S Sohal
- Newark Beth Israel Medical Center , Newark , United States of America
| | - H Rawal
- Insight Hospital and Medical Center , Chicago , United States of America
| | - M Turagam
- Mount Sinai Hospital , New York , United States of America
| | - Y Gwon
- University of Nebraska Medical Center , Omaha , United States of America
| | - M Mamas
- Keele University , Keele , United Kingdom
| | - A Dominguez
- Mount Sinai St Luke's and Mount Sinai West Hospital , New York , United States of America
| | - D Bhatt
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - P Velagapudi
- University of Nebraska Medical Center , Omaha , United States of America
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5
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Kaur A, Dhaliwal A, Khandait H, Konje S, Bhatia K, Sohal S, Turagam M, Gwon Y, Mamas M, Dominguez A, Bhatt D, Velagapudi P. To compare efficacy and safety of direct oral anticoagulants in patients with concurrent atrial fibrillation and bioprosthetic heart valve repair or replacement: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Use of direct oral anticoagulants (DOACs) is contraindicated in patients with mechanical valves. However data on their use in patients with atrial fibrillation (AF) and bioprosthetic valves (BV) is still limited.
Purpose
To assess the safety and efficacy of DOACs versus Vitamin K antagonist (VKA) in patients with AF after BV repair or replacement.
Methods
We performed a comprehensive review of electronic databases (PubMed, Embase, Scopus, Cochrane) using MeSH terms and keywords for DOACs, AF and BVs from inception through December 2021. Randomized clinical trials (RCT) or observational studies that reported clinical outcomes comparing DOACs versus VKA in patients with AF and BVs were eligible for inclusion. Ten articles were reviewed for full text. Primary outcome was a composite of all cause stroke or systemic embolic event.
Secondary outcomes included major bleeding and all-cause mortality. Subgroup analysis stratified by study design was performed. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using Mantel-Haenszel method with DerSimonian-Laird estimator for tau2 for random effects model.
Interstudy heterogeneity was assessed using the Higgins I 2 value. All statistical analysis was performed using RevMan 5.4.1 software.
Results
Ten studies (5 RCTs, 5 observational studies) with a total of 5,333 patients (DOACs n=2434; VKA n=2899) were included. Aortic, mitral and mixed BV repair or replacement were 74.2%, 25.6% and 0.02% respectively. The mean age was 72.6±11.9 years. The mean follow-up was 15.7±12.9 months. Type of DOACs included apixaban (n=553, 22.7%), rivaroxaban (n=893, 36.7%), dabigatran (n=151, 6.2%) and edoxaban (n=837, 34.4%). There was no significant difference in primary outcome of stroke or systemic embolic event (RR: 0.79; CI: 0.56–1.11; p>0.05; I2=12%) or secondary outcomes of major bleeding (RR: 0.84; CI: 0.64–1.11; p>0.05; I2=45%), and all-cause mortality (RR: 0.84; CI: 0.64–1.11; p>0.05; I2=29%) between DOACs compared with VKA.
Conclusion
In patients with AF and BV, DOACs are non-inferior to VKA for risk of stroke or systemic embolism, major bleeding, and all-cause mortality. Thus, DOACs can serve as a viable alternative to VKAs which have a narrow therapeutic index, multiple drug interactions, and require frequent monitoring.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kaur
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - A Dhaliwal
- New York Hand Surgery , New York , United States of America
| | - H Khandait
- Trinitas Regional Medical Center, Elizabeth , New Jersey , United States of America
| | - S Konje
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - K Bhatia
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - S Sohal
- Newark Beth Israel Medical Center , Newark , United States of America
| | - M Turagam
- Mount Sinai Hospital , New York , United States of America
| | - Y Gwon
- University of Nebraska Medical Center , Omaha , United States of America
| | - M Mamas
- Keele University , Keele , United Kingdom
| | - A Dominguez
- Icahn School of Medicine at Mount Sinai Morningside West , New York City , United States of America
| | - D Bhatt
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | - P Velagapudi
- University of Nebraska Medical Center , Omaha , United States of America
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Cipolletta E, Nakafero G, Mamas M, Avery A, Tata L, Abhishek A. POS1172 RISK OF VENOUS THROMBOEMBOLISM AFTER GOUT FLARES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4633] [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] [Indexed: 11/03/2022]
Abstract
BackgroundSeveral population-based cohort studies have reported an increased risk of venous thromboembolism (VTE) in gout patients. However, none of these studies has investigated the temporal relationship between gout flares and VTE.ObjectivesTo explore whether gout flares increase the risk of VTE in the short-term using the self-controlled case series (SCCS) method.MethodsWe identified participants with incident gout from the Clinical Practice Research Datalink (CPRD). Participants having less than one year of registration in CPRD and patients with a history of VTE or anticoagulant prescription more than one year before the first gout consultation were excluded.Participants with at least one gout flare and a diagnosis of VTE were selected. VTEs and gout flares were ascertained using primary care data, hospitalisation and mortality records, using previously validated algorithms (positive predictive value of 94% for VTE [1] and 68-95% for gout flares [2,3]).SCCS method involves fitting a Poisson model conditioned on the number of VTEs, and it calculates the adjusted incidence risk ratio (aIRR) and its 95% confidence interval (95%CI) for each stratum of the “at-risk” period as compared with the “baseline” period (Figure 1). The analysis was adjusted for age and calendar season.Figure 1.Schematic description of the observation period (“at-risk” and baseline periods).The “at-risk” period (in red) was defined as the period following the exposure (the gout flare), and it was subdivided as follows: days 0-30, 31-60 and 61-120 after each gout flare. The baseline period (in green) consisted of a pre-exposure and a post-exposure period of 365 days each.The length of each period varied according to the occurrence of the next flare and its timing. Panel A and panel B provide a schematic representation of patients with a single observation period and with multiple “non-overlapping” observation periods, respectively. In such cases, the length of the “at risk” period was 120 days, while the length of the pre-exposure and post-exposure period was 365 days each.ResultsAmong the 104,962 patients with an incident diagnosis of gout in CPRD between 1997 and 2020, we identified 2,678 VTE (4.0 events/1,000 person-years).There were 53 VTE (13.3 events/month) during the “at-risk” period and 143 (6.0 events/month) during the “baseline” period (crude incidence rate ratio, 1.75; 95%CI: 1.27-2.42). The rates were highest in the first month after gout flares and then fell progressively (Table 1). Sensitivity analyses were consistent with the main analysis (Table 1).Table 1.Gout flareNumber of events per monthaIRR (95%CI)ptrendMain analysis0-30 days17.02.11 (1.27-3.50)0.0131-60 days14.01.86 (1.07-3.24)61-90 days11.01.50 (0.95-2.37)Baseline period6.0ReferenceSensitivity analysis (excluding participants with risk factors for VTE) [4]0-30 days14.03.13 (1.77-5.53)0.0131-60 days7.01.66 (0.76-3.61)61-90 days8.01.75 (0.94-3.37)Baseline period3.4ReferenceConclusionA transitory increase in the risk of VTE was observed after gout flares.References[1]Huerta C, et al. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007;167:935-43.[2]Zheng C, et al. Using natural language processing and machine learning to identify gout flares from electronic clinical notes. Arthritis Care Res (Hoboken). 2014;66:1740-8.[3]MacFarlane LA, Liu et al. Validation of claims-based algorithms for gout flares. Pharmacoepidemiol Drug Saf. 2016;25:820-6.[4]Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.Disclosure of InterestsNone declared
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Rathod-Mistry T, Mamas M, Bailey J, Chen Y, Clarson L, Denaxas S, Hayward R, Hemingway H, Van Der Windt D, Jordan K. Comparison of risk factors for coronary event in people with unattributed and non-coronary chest pain: an electronic health record cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients presenting to primary care with chest pain are often not given a cause. Patients with such unattributed chest pain have an increased risk of future cardiovascular disease (CVD) compared to patients with diagnosed non-coronary chest pain. It is unknown whether risk factors for CVD determined in the general population are the same for the population with unattributed or non-coronary chest pain.
Purpose
To determine if key risk factors for a coronary event in patients with unattributed chest pain are similar to those for patients with non-coronary chest pain and previously identified in the general population.
Methods
The study used primary care information from the Clinical Practice Research Datalink Aurum linked to hospital inpatient and mortality data. Patients aged ≥18 years with an incident record of unattributed or non-coronary chest pain in 2002–2018 and no diagnosis of CVD were included. We included as potential risk factors those established for CVD in the general population and non-coronary explanations for chest pain. Flexible parametric models estimated hazard ratios (95% confidence intervals (CI)) between factors and incident coronary event (defined as myocardial infarction, angina, coronary heart disease, percutaneous intervention, and coronary artery bypass graft surgery).
Results
There were 375,240 patients with unattributed chest pain (53% female: mean age 49; 47% male: mean age 47) and 245,329 patients with non-coronary chest pain (58% female: mean age 47; 42% male: mean age 44). Median duration of follow-up was 5 years. In the unattributed chest pain group, there were 111 (95% CI: 109, 112) and 140 (138, 142) coronary events per 10,000 person-years in females and males, respectively. Lower rates of coronary event were observed in the non-coronary chest pain group (females: 73 (72, 75); males: 96 (94, 98)). Within females (Figure), in both chest pain groups the strongest risk factors were type I and type II diabetes, atrial fibrillation, and hypertension whereas no associations were observed for migraine and chronic kidney disease. Whilst alternative explanations for non-coronary chest pain also increased the risk of coronary events, associations were less strong than for established general population risk factors. Similar findings were found in males although family history of coronary event was a stronger risk factor in the non-coronary chest pain group compared to the unattributed chest pain group.
Conclusions
The pool of factors found to increase the risk of coronary events in patients presenting with recorded unattributed or non-coronary chest pain are similar but not identical to those identified for the general population. Further research is needed to develop prognostic models to identify patients at the most risk of a coronary event as models developed in the general population are unlikely to be applicable given the increased underlying risk of coronary events in these populations.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Study funded by the British Heart Foundation, reference PG/19/46/34307. KJ also supported by matched funding awarded to the NIHR Applied Research Collaboration (West Midlands). Risk factors for coronary event
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Affiliation(s)
- T Rathod-Mistry
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
| | - M Mamas
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
| | - J Bailey
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
| | - Y Chen
- Xi'an Jiaotong - Liverpool University, Suzhou, China
| | - L Clarson
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
| | - S Denaxas
- University College London, Health Data Research UK, London, United Kingdom
| | - R Hayward
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
| | - H Hemingway
- University College London, Health Data Research UK, London, United Kingdom
| | - D Van Der Windt
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
| | - K Jordan
- Keele University, Primary Care Centre Versus Arthritis, School of Medicine, Keele, United Kingdom
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Eliya Y, Averbuch T, Le N, Xie F, Thabane L, Mamas M, Van Spall H. Temporal trends in the inclusion of patient-reported outcomes in heart failure randomized trials published in high-impact medical journals: a systematic bibliometric review. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patient reported outcomes (PROs) are important measures of health, particularly in symptomatic conditions such as heart failure (HF), and regulatory agencies have encouraged their collection in randomized controlled trials (RCTs).
Purpose
To assess temporal trends in the inclusion of patient-reported outcomes (PROs) in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals, explore trial characteristics associated with inclusion of PROs, and describe the quality of PRO reporting in HF RCTs.
Methods
We searched MEDLINE, EMBASE and CINAHL for studies published between January 1, 2000 and July 17, 2020. We included RCTs published in journals with impact factor ≥10. We assessed temporal trends using the Jonckheere-Terpstra test and conducted multivariable logistic regression analysis to explore trial characteristics independently associated with inclusion of PROs. We assessed the quality of PRO reporting using the Consolidated Standards for Trial Reporting PRO extension statement.
Results
We identified 12,342 articles, of which 417 RCTs met inclusion criteria. PROs were included in 224 RCTs (53.7%, 95% confidence interval [CI]: 48.8%-58.6%), of which 44 (19.6%) reported PRO as primary or co-primary endpoint. The proportion of RCTs with PROs increased significantly between 2000–2003 (37.4%) and 2016–2020 (65.1%) (p<0.001). PROs had higher odds of inclusion in RCTs that were multicenter (odds ratio [OR]: 1.95; 95% CI: 1.05–3.64; p=0.036); medium-sized (n=51–250) (OR: 2.29; 95% CI: 1.24–4.23; p=0.008); coordinated in in Central and South America (OR: 6.79; 95% CI: 1.34–34.36; p=0.021); and assessed health services (OR: 4.21; 1.97–8.98; p<0.001), device / surgical (OR: 6.24; 95% CI 3.05–12.80; p<0.001), or exercise and rehabilitation interventions (OR: 3.98; 95% CI 1.59–9.97; p=0.003). A majority (54.9%) of the 224 RCTs reported four or less of the eleven CONSORT-PRO items. The median number of CONSORT-PRO items reported was 4 (interquartile range [IQR] 3–6 items per trial), with improved reporting in trials with PRO as primary or co-primary endpoint.
Conclusions
PROs are included in in just over half of HF RCTs, with an increased reporting of PROs between 2000 and 2020. Large, pharmacotherapy trials conducted in North America and Europe were less likely to include PROs. The quality of PRO reporting in HF RCTs was modest, with trials most often reporting four of eleven CONSORT-PRO items.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research
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Affiliation(s)
- Y Eliya
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada
| | - T Averbuch
- McMaster University, Department of Medicine, Hamilton, Canada
| | - N Le
- McMaster University, Department of Medicine, Hamilton, Canada
| | - F Xie
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada
| | - L Thabane
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada
| | - M Mamas
- Keele University, Keele Cardiovascular Research Group, Keele, United Kingdom
| | - H Van Spall
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada
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Hinton J, Augustine M, Gabara L, Mariathas M, Allan R, Borca F, Nicholas Z, Ikwoube J, Gillett N, Kwok CS, Cook P, Grocott MPW, Mamas M, Curzen N. Incidence and one year outcome of periprocedural myocardial infarction following cardiac surgery: are the universal definition and SCAI criteria fit for purpose? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The diagnosis and clinical implication of periprocedural myocardial infarction (PPMI) following coronary artery bypass grafting (CABG) is contentious, especially given its importance in the interpretation of trial data. Two accepted definitions of PPMI yield discrepant results. Little is known about the association between the diagnosis of PPMI, using high sensitivity troponin (hs-cTn), and medium term mortality in patients who undergo CABG, either alone or in conjunction with another procedure. In addition, there are currently no criteria for the diagnosis of PPMI following non-CABG surgery.
Method
Consecutive patients admitted to a cardiothoracic critical care unit (CCCU) over a six month period following open cardiac surgery had hs-cTnI assay performed on admission and every day for forty-eight hours, regardless of whether there was a clinical indication. Patients were categorised as PPMI using both the Universal Definition of MI (UDMI) and Society of Cardiovascular Angiography and Interventions (SCAI) criteria. Comorbidity data, surgical details and clinical progress in CCCU were recorded. One year mortality data were obtained from NHS Digital.
Results
There were 245 CABG patients, of whom 20.4% met criteria for UDMI PPMI and 87.6% for SCAI UDMI (figure 1). The diagnosis of UDMI PPMI was independently associated with one year mortality (hazard ratio 4.175 (95% confidence interval 1.281 – 13.608)), whereas there was no association between SCAI PPMI and one year mortality (figure 2). Of the 243 patients who had non CABG cardiac surgery, 11.4% met criteria for UDMI PPMI and 85.2% for SCAI PPMI (figure1) but neither was associated with one year mortality.
Conclusions
The incidence of SCAI PPMI in a real world cohort of cardiac surgery patients is so high as to be of limited clinical value. By contrast, a diagnosis of UDMI PPMI post CABG is independently associated with one year mortality, so may have clinical utility.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Beckman Coulter - supplied the assays used in the study but had no role in the study Figure 1. Frequency of PPMIFigure 2. Kaplan Meier curves
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Affiliation(s)
- J Hinton
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Augustine
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - L Gabara
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Mariathas
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - R Allan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - F Borca
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Z Nicholas
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - J Ikwoube
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - N Gillett
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - C S Kwok
- Keele University, Keele, United Kingdom
| | - P Cook
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M P W Grocott
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Mamas
- Keele University, Keele, United Kingdom
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Hinton J, Augustine M, Gabara L, Mariathas M, Allan R, Borca F, Nicholas Z, Gillett N, Kwok CS, Cook P, Grocott MPW, Mamas M, Curzen N. The relationship between high-sensitivity troponin taken on admission to critical care, regardless of whether there was a clinical indication for testing, and one year mortality. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
High-sensitivity troponin (hs-cTn) assays now form a key component of the diagnostic pathways for patients presenting to emergency medical services with chest pain. However, hs-cTn concentrations above the manufacturer-provided upper limit of normal (ULN) are now frequently reported in patients presenting with conditions not traditionally associated with type 1 myocardial infarction (T1MI). This is particularly true of severe illness states. We investigated the possible association between hs-cTn and 1 year mortality in critical care patients.
Method
Consecutive patients admitted to two adult critical care units (general critical care unit (GCCU) and neuroscience critical care unit (NCCU)) over a six month period had hs-cTnI assay performed on admission, regardless of whether there was a clinical indication, and the results nested unless a clinical request had been made. Comorbidity data, illness severity and critical care outcome were recorded and have been previously reported. One year mortality data were obtained from NHS Digital.
Results
After excluding patients diagnosed with T1MI by the clinical team, there were 1,033 patients remaining. At one year a total of 253 (24.5%) patients had died. The Kaplan-Meier curves in figure 1 demonstrate a positive association between mortality and increasing hs-cTnI concentrations relative to the ULN. Specifically, using the log-rank test, the mortality at one year was significantly higher (p<0.001) in patients with hs-cTnI concentrations above the ULN. Furthermore, on multivariable Cox regression analysis, the log(10) hs-cTnI concentration was independently associated with the hazard of one year mortality (hazard ratio 1.587 (95% confidence interval 1.358–1.856).
Conclusions
These data suggest that admission hs-cTnI is a biomarker for one year mortality in critical care patients. Further work is now required to assess whether any medical intervention can alter this risk.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Beckman Coulter provided the assays for the tests used in this study. They had no other involvement in the study
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Affiliation(s)
- J Hinton
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Augustine
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - L Gabara
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Mariathas
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - R Allan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - F Borca
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Z Nicholas
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - N Gillett
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - C S Kwok
- Keele University, Keele, United Kingdom
| | - P Cook
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M P W Grocott
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Mamas
- Keele University, Keele, United Kingdom
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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11
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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Borovac J, Kwok C, Mohamed M, Fischman D, Savage M, Alraies C, Kalra A, Nolan J, Zaman A, Ahmed J, Bagur R, Mamas M. The predictive value of CHA2DS2-VASc score on adverse in-hospital outcomes among patients with the acute coronary syndrome and atrial fibrillation who undergo PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and having concomitant atrial fibrillation (AF) have a greater risk of adverse short- and long-term outcomes and death compared with patients in the same setting but without AF. On the other hand, the predictive value of CHA2DS2-VASc score in terms of in-hospital mortality and periprocedural adverse events following PCI among patients with ACS and AF is unknown.
Purpose
We retrospectively analyzed data of patients with the main admission diagnosis of ACS that underwent PCI and had AF during the 2004–2014 period from the large nationwide US National Inpatient Sample (NIS) database.
Methods
A CHA2DS2-VASc score was calculated for each patient and incorporated into a multivariable-adjusted logistic regression to determine its independent impact on in-hospital outcomes consisting of death, acute kidney injury (AKI), bleeding, vascular injury, and stroke/transient ischemic attack (TIA).
Results
A total of 283,890 patients with AF who underwent PCI following ACS were included in the analysis. The average reported prevalence of the AF in the whole cohort was 10.0% with a significant trend (p<0.001) of increase during the observed 10-year period. The average age of the cohort was 72.1±11 years, 63.4% were male while the median CHA2DS2-VASc score was 3 (IQR 2–4). Crude rates of adverse in-hospital outcomes were significantly higher among patient groups with higher CHA2DS2-VASc score (Table 1). Following adjustment for baseline covariates, incremental increase in CHA2DS2-VASc score was independently associated with an increased odds of in-hospital death (OR 1.20, CI 95% 1.18–1.22), periprocedural vascular injury (OR 1.18, 95% CI 1.17–1.20), bleeding (OR 1.17, 95% CI 1.16–1.18), stroke/TIA (OR 1.17, 95% CI 1.15–1.19), and AKI (OR 1.05, 95% CI 1.04–1.06) (Figure 1).
Conclusions
The CHA2DS2-VASc score provides important prognostic information in ACS patients with AF undergoing PCI and is independently associated with in-hospital death and periprocedural adverse events. Therefore, CHA2DS2-VASc score could be used as a practical and inexpensive tool for risk stratification in this population.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J.A Borovac
- Keele University, Stoke-on-Trent, United Kingdom
| | - C.S Kwok
- Keele University, Stoke-on-Trent, United Kingdom
| | - M.O Mohamed
- Keele University, Stoke-on-Trent, United Kingdom
| | - D.L Fischman
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - M Savage
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - C Alraies
- Detroit Medical Center, Detroit, United States of America
| | - A Kalra
- Cleveland Clinic, Cleveland, United States of America
| | - J Nolan
- Keele University, Stoke-on-Trent, United Kingdom
| | - A Zaman
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - J Ahmed
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - R Bagur
- Keele University, Stoke-on-Trent, United Kingdom
| | - M.A Mamas
- Keele University, Stoke-on-Trent, United Kingdom
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13
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Wu P, Chew-Graham C, Maas A, Chappell L, Potts J, Gulati M, Jordan K, Mamas M. Hypertensive disorders of pregnancy and impact on in-hospital cardio-obstetric outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown.
Methods
Using the United States National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension and gestational hypertension) were analysed to examine the association between HDP and adverse in-hospital outcomes.
Results
We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (OR 7.83, 95% CI 6.25, 9.80), myocardial infarction (OR 5.20, 95% CI 3.11, 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64, 5.26), preterm birth (OR 4.65, 95% CI 4.48, 4.83), placental abruption (OR 2.22, 95% CI 2.09, 2.36), and stillbirth (OR 1.78, 95% CI 1.66, 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic SH without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic SH are at even higher risk of some adverse outcomes compared to women with preeclampsia.
Conclusion
The chronic hypertension population, with and without superimposed preeclampsia, is a particularly high risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIHR
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Affiliation(s)
- P Wu
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - C Chew-Graham
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - A Maas
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - L Chappell
- University College London, London, United Kingdom
| | - J Potts
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - M Gulati
- University of Arizona, Phoenix, United States of America
| | - K Jordan
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
| | - M Mamas
- Keele University, School of Primary, Social and Community Care, Stoke-on-Trent, United Kingdom
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14
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Mohamed M, Volgman A, Contractor T, Sharma P, Kwok C, Martin G, Barker D, Patwala A, Mamas M. Trends of sex differences in outcomes of cardiac electronic device implantations in the United States. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is limited evidence on the differences in procedural outcomes between sexes after de novo cardiac implantable electronic device implantation (CIED). Furthermore, it is unclear whether any sex-based disparities have changed over the years.
Purpose
To compare procedural outcomes of de novo CIED implantation between sexes and study the trends of these outcomes over a 11-year period in a nationally representative sample.
Methods
Using the National Inpatient Sample, all hospitalisations between 2004 and 2014 for de novo CIED implantation were included, stratified by sex. Multivariable logistic regression was performed to 1) examine the association between sex and in-hospital complications of CIED implantation, expressed as odds ratios (OR) with 95% confidence intervals (CI), and 2) analyse trends of in-hospital outcomes by assessing the interaction term between time (years) and sex as covariates.
Results
Out of 2,815,613 hospitalisations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased adjusted odds of major adverse cardiovascular events (composite of mortality, thoracic and cardiac complications; OR 1.17 95% CI 1.16, 1.19), procedure-related bleeding (OR 1.13 95% CI 1.12, 1.15), and local complications (thoracic: OR 1.42 95% CI 1.40, 1.44, cardiac: OR 1.44 95% CI 1.38, 1.50). (p<0.001 for all) Notably, there was no difference in odds of all-cause mortality between sexes (OR women: 0.96 95% CI 0.94, 1.00). The odds of adverse complications in the overall CIED cohort were persistently raised in women throughout the study period, whereas similar odds of all-cause mortality across the sexes were observed throughout the study period (see Figure).
Conclusion
In a national cohort of CIED implantations we demonstrate that women are at a persistently higher risk of procedure-related adverse events other than mortality compared to men. This trend is concerning and warrants further work on procedural techniques to neutralise these sex disparities.
Trends of odds of complications in women
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This work constitutes part of a PhD for MOM that is supported by Medtronic Ltd. Medtronic Ltd. was not involved in the conceptualization, design, conduct, analysis, or interpretation of the current study.
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Affiliation(s)
- M Mohamed
- Keele University, Keele, United Kingdom
| | - A.S Volgman
- Rush University Medical Center, Cardiology, Chicago, United States of America
| | - T Contractor
- Loma Linda University Medical Center, Loma Linda, United States of America
| | - P.S Sharma
- Rush University Medical Center, Cardiology, Chicago, United States of America
| | - C.S Kwok
- Keele University, Keele, United Kingdom
| | - G.P Martin
- University of Manchester, Manchester, United Kingdom
| | - D Barker
- Royal Stoke University Hospital, Cardiology, Stoke-on-Trent, United Kingdom
| | - A Patwala
- Royal Stoke University Hospital, Cardiology, Stoke-on-Trent, United Kingdom
| | - M.A Mamas
- Keele University, Keele, United Kingdom
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15
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Mohamed W, Hirji S, Mohamed M, Percy E, Braidley P, Chung J, Aranki S, Mamas M. Incidence and predictors of postoperative ischaemic stroke after coronary artery bypass grafting in the United States. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Postoperative acute ischemic stroke (AIS) is a catastrophic complication of coronary artery bypass grafting (CABG). There is limited data on the incidence and outcomes of AIS complicating CABG in the contemporary era, and whether these have changed over the years.
Purpose
To study the incidence and outcomes of postoperative AIS in a nationally representative cohort of CABG procedures over a 12-year period and examine predictors of AIS in patients undergoing CABG.
Methods
The National Inpatient Sample was used to identify all adult patients (>18 years old) who underwent CABG in the United States between January 2004 and September 2015. Multivariable logistic regression was performed to examine the associations between postoperative AIS and in-hospital mortality and identify predictors of AIS after CABG, expressed as odds ratios (OR) with corresponding 95% confidence intervals (CI).
Results
A total of 2,569,597 CABG operations were analysed. The incidence of postoperative AIS was 1.8% (n=47,279) in the overall cohort increasing from 1.2% in 2004 to 2.3% in 2015 (p<0.001). Significantly higher rates of AIS were observed amongst patients with atrial fibrillation (AF) and those undergoing non-elective or concomitant valve operations over the study period (see Figure). Patient risk profiles increased over time in both AIS and no-AIS cohorts, with higher Charlson comorbidity scores observed amongst AIS patients. AIS was independently associated with increased odds of in-hospital mortality (OR 3.03, 95% CI 2.93, 3.13) and prolonged hospital stay (∼6 more days) and a higher hospitalisation cost (∼$80,000 more) (p<0.001 for all). Several factors were predictors of AIS including age>60 years (61–70 years: OR 1.33, 95% CI 1.29, 1.37; 71–80 years: OR 1.49, 95% CI 1.44, 1.54; >80 years: OR 1.42, 95% CI 1.37, 1.48), female sex (OR 1.33, 95% CI 1.31, 1.36) and AF (OR 1.14 95% CI 1.12, 1.16) (p<0.001 for all). In contrast, on-pump CABG was not an independent predictor of stroke (OR 1.01, 95% CI 0.94, 1.09) (p=0.784).
Conclusion
In this nationally representative study, we have shown that the rates of postoperative stroke following CABG have increased over time in line with complexity of patient risk profiles. The present findings emphasise the need for further work on strategies to reduce the risk of postoperative stroke after CABG.
Trends of postoperative AIS (2004-2015)
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- W Mohamed
- Glenfield Hospital, Leicester, United Kingdom
| | - S Hirji
- Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, United States of America
| | - M Mohamed
- Keele University, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele, United Kingdom
| | - E Percy
- Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, United States of America
| | - P Braidley
- Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - J Chung
- Loma Linda University Medical Center, Department of Cardiac Surgery, Loma Linda, United States of America
| | - S Aranki
- Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, United States of America
| | - M.A Mamas
- Keele University, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele, United Kingdom
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16
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Parmar S, Mohamed M, Wilkie R, Mamas M. The association between osteoarthritis and invasive treatment and clinical outcomes in 6.5 million patients presenting with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People with osteoarthritis (OA) have an increased risk of cardiovascular disease, including acute myocardial infarction (AMI). Despite OA being the most common joint condition and the fastest increasing major health condition, there is limited information on the management strategies and subsequent outcomes of OA patients presenting with AMI.
Purpose
To describe the association between OA and invasive management strategies (including coronary angiography (CA), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)) and clinical outcomes.
Methods
We analysed all hospitalisations for AMI between 2004 and 2015 recorded in the National Inpatient Sample (NIS), the largest inpatient electronic health record database in the United States. The proportion of patients receiving CA, PCI, and CABG were compared between patients with and without OA, as were the proportions of in-hospital adverse events including major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, cardiac complications and acute stroke), in-hospital mortality, stroke, and major bleeding. Multivariate logistic regression modelling with adjustment for potential confounders (demographics, medical history, and comorbidities) was performed to examine associations between OA and in-hospital clinical outcomes; results are expressed as adjusted odds ratios (AdjOR) with 95% confidence intervals (95% CI).
Results
A total of 6,561,940 people were hospitalised for AMI between January 2004 and September 2015, of which 444,217 (6.8%) had a concurrent diagnosis of OA. On average, those with OA were older (median: 77 vs. 67 years), more likely to be female (55.7% vs. 38.6%), and less likely to receive CA (55.3% vs. 65.2%), PCI (33.3% vs. 43.6%), and CABG (7.4% vs. 8.5%) (Figure 1A, p<0.001 for all). After adjustment for confounders, OA was associated with a lower likelihood of receiving CA (AdjOR 0.89; 95% CI 0.87, 0.90), PCI (0.85; 0.84, 0.87), and CABG (0.92; 0.90, 0.94). With reference to outcomes, OA was associated with lower likelihood of in-hospital adverse events (MACCE: AdjOR 0.71; 95% CI 0.69, 0.72; in-hospital mortality: 0.69; 0.67, 0.71; stroke: 0.81; 0.77, 0.85; and major bleeding: 0.73; 0.70, 0.75) (Figure 1B, p<0.001 for all).
Conclusion
In a national cohort of AMI hospitalisations, patients with OA were less likely to receive invasive management compared to those without OA. However, they were also less likely to experience adverse events. Further work is required to investigate treatment disparities in this increasingly prevalent patient group when presenting with AMI.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Parmar
- Keele University, School of Primary, Community and Social Care, Stoke-on-Trent, United Kingdom
| | - M Mohamed
- Keele University, Keele Cardiovascular Research Group, Stoke-on-Trent, United Kingdom
| | - R Wilkie
- Keele University, School of Primary, Community and Social Care, Stoke-on-Trent, United Kingdom
| | - M Mamas
- Keele University, Keele Cardiovascular Research Group, Stoke-on-Trent, United Kingdom
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17
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Mohamed M, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas M. Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness.
Purpose
To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI.
Methods
All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).
Results
Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17).
Conclusion
Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.
Odds of management and clinical outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Mohamed
- Keele University, Cardiology, Keele, United Kingdom
| | - M Rashid
- Keele University, Keele, United Kingdom
| | - S Farooq
- Keele University, Keele, United Kingdom
| | - N Siddiqui
- Nevill Hall Hospital, Abergavenny, United Kingdom
| | - P Parwani
- Loma Linda University Medical Center, Loma Linda, United States of America
| | - D Shiers
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - R Thamman
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, United States of America
| | - M Gulati
- University of Arizona College of Medicine, Phoenix, United States of America
| | - A Shoaib
- Keele University, Cardiology, Keele, United Kingdom
| | | | - M.A Mamas
- Keele University, Cardiology, Keele, United Kingdom
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18
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Hinton J, Augustine M, Gabara L, Mariathas M, Allan R, Borca F, Nicholas Z, Beecham R, Kwok S, Cook P, Grocott M, Mamas M, Curzen N. Distribution of high sensitivity troponin taken without conventional clinical indications in critical care patients and its association with mortality. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
High sensitivity troponin (hs-cTn) concentrations above the manufacturer's upper limit of normal (ULN) are frequently seen outside the context of MI, particularly in critical care units. The current evidence regarding the prognostic value of hs-cTn in critical care settings is discrepant.
Purpose
To describe the distribution of hs-cTn in a consecutive cohort of patients in critical care units, regardless of whether there is a conventional clinical indication, and the association of this distribution with clinical outcomes.
Methods
Consecutive patients admitted to three adult critical care units (cardiothoracic (CCU), general (GCU), neuroscience (NCU)) over a six month period had hs-cTnI tests performed serially throughout the admission, regardless of whether the supervising team felt there was a clinical indication. The results were nested and not revealed to patients or clinicians unless they were requested as part of routine care. The hs-cTnI results were correlated with parameters of clinical outcome.
Results
After excluding those diagnosed with a type 1 MI, there were 1,563 patients remaining in the study cohort (CCU 530, GCU 750, NCU 283). The median hs-cTnI was 77ng/L (IQR 11–1932ng/L, with 1081 (69.2%) patients above the manufacturer-provided ULN. Overall there was a bimodal distribution; GCU and NCU were positively skewed and CCU negatively skewed. Hs-cTnI concentrations above the ULN were associated with age, comorbidity, illness severity and need for organ support (table 1). The degree by which the hs-cTnI concentration was above the ULN remained an independent predictor of critical care mortality (figure 1) in NCU and GCU.
Conclusion
Hs-cTnI elevation taken outside the context of conventional clinical indications is common in the critically ill and is associated with age, comorbidity and illness severity. Admission hs-cTnI is an independent predictor of mortality and provides additional discriminative ability to the APACHE II score alone. This assay may represent a novel prognostic biomarker on admission in non-CCU critical care settings.
Mortality relative to ULN
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Beckman Coulter
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Affiliation(s)
- J Hinton
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Augustine
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - L Gabara
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M Mariathas
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - R Allan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - F Borca
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Z Nicholas
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - R Beecham
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - S Kwok
- Keele University, Keele, United Kingdom
| | - P Cook
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M.P.W Grocott
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - M.A Mamas
- Keele University, Keele, United Kingdom
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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19
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Nakafero G, Grainge M, Valdes A, Townsend N, Mallen C, Zhang W, Doherty M, Mamas M, Abhishek A. FRI0610-HPR Β-ADRENORECEPTOR BLOCKING DRUGS ASSOCIATE WITH LOWER RISK OF KNEE OSTEOARTHRITIS AND KNEE PAIN CONSULTATIONS IN PRIMARY CARE: A PROPENSITY SCORE MATCHED COHORT STUDY USING THE CLINICAL PRACTICE RESEARCH DATALINK. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.141] [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] [Indexed: 11/03/2022]
Abstract
Background:The pharmacologic management of OA is centred around optimising pain control but first-line analgesics only have modest efficacy1. Findings from several studies suggest thatβ-adrenoreceptor blocking drugs (β-blockers) have anti-nociceptive effects2 3. However, evidence for the benefits of β-blockers in the context of OA pain is scarce. We recently demonstrated, for the first time, an association between beta-blockers and lower pain severity, and less opioid analgesic use in a secondary analysis of data for community dwelling adults with large-joint lower OA4. This association, however, was not confirmed in a hospital-based study5.Objectives:We examined [1] the association betweenβ-blocker prescription and first primary care consultation for knee OA, hip OA, knee pain, and hip pain and [2] the classes ofβ-blocker drugs that reduce the risk of these outcomes.Methods:This was a cohort study using data from the UK Clinical Practice Research Datalink. Participants aged ≥40 years, in receipt of ≥2 β-blocker prescriptions within 60 days were matched by age, sex, and propensity score (PS) for β-blocker prescription to one control using greedy nearest neighbour matching. Participants with chronic painful conditions, contra-indications to β-blockers, maintenance analgesic prescriptions, and with <2-years registration before index or matched follow-up start date were excluded. Cox proportional hazard ratios (aHRs) and 95% confidence intervals (CI) were calculated to examine the associations adjusted for other covariates. Analyses were stratified according to β-blocker classes.Results:Data for 223,436 PS-matched exposed and un-exposed participants were included. β-blocker prescription associated with a significantly reduced risk of knee OA, knee pain, and hip pain consultations with aHR(95%CI) 0.90(0.83–0.98), 0.88(0.83–0.92), 0.85(0.79–0.90) respectively. The reduction in hip OA lacked statistical significance (aHR 95%CI 0.94; 0.83-1.07) (Table 1). On stratified analysis, propranolol and atenolol had a statistically significant protective effect on knee OA and knee pain consultations with aHRs between 0.78 and 0.91 (Figure 1).Table 1.The association between β-blocker prescription and incident osteoarthritis and joint painOutcomesExposedEvents (n)Person-timeEvent rate (95% CI)*HR (95% CI)1Knee OANo986262,0033.76 (3.54 – 4.01)1.00Yes1,101307,2313.58(3.38 – 3.80)0.90(0.83 – 0.98)Hip OANo451263,7531.71(1.56– 1.87)1.00Yes530310,0451.71(1.57 – 1.86)0.94(0.83 – 1.07)Knee painNo3,074255,00312.06(11.64 – 12.49)1.00Yes3,560297,02711.99(11.60 – 12.37)0.88(0.83 – 0.92)Hip painNo1,767259,5156.81 (6.50 – 7.13)1.00Yes1,981304,4546.51 (6.23 - 6.80)0.85(0.79 – 0.90)OA; osteoarthritis, *1,000 person-years,1PS matched and, additionally adjusted for age, number of GP consultations, hospital out-patient referrals, hospital admissions in the 12 month period preceding cohort entry, total number of GP consultations for knee or hip injury prior to cohort entry and non-osteoporotic fractures.Figure 1.The association between individual β-adrenoreceptor blocking drugs and incident knee osteoarthritis and knee pain11Comparison group is unexposed to β-blockers; size of the square is proportional to number of events.Conclusion:β-blockers appear to reduce consultations for knee OA, and knee or hip pain. Our results imply that, atenolol might be used preferentially for the treatment of people with cardiovascular comorbidities, while, propranolol with its’ anti-anxiety effect may be a suitable analgesic in people with OA and comorbid anxiety.References:[1] McAlindon TE, et al. Osteoarthritis and Cartilage 2014;22(3):363-88.[2] Harkanen L, et al. Journal of anesthesia 2015;29(6):934-43. doi: 10.1007/s00540-015-2041-9[3] Light KC, et al. The journal of pain 2009;10(5):542-52. doi: 10.1016/j.jpain.2008.12.006[4] Valdes AM, et al. Arthritis Care Res (Hoboken) 2017;69(7):1076-81. doi: 10.1002/acr.23091[5] Zhou L,et al. Osteoarthritis and Cartilage 2019 doi:https://doi.org/10.1016/j.joca.2019.08.008Acknowledgments:This work was funded by the National Institute for Health Research (grant numbers: PB-PG-0816-20025 and NIHR-RP-2014-04-026).Disclosure of Interests:Georgina Nakafero: None declared, Matthew Grainge: None declared, Ana Valdes Grant/research support from: Pfizer Inc, Consultant of: Consultant for Heel GmBH, Nick Townsend: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Mamas Mamas: None declared, Abhishek Abhishek Consultant of: Consulting for Inflazome, and Royalties from Uptodate and Springer
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20
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Mohamed MO, Lopez-Mattei JC, Iliescu CA, Purwani P, Bharadwaj A, Kim PY, Palaskas NL, Rashid M, Potts JE, Kwok CS, Gulati M, Al Zubaidi AB, Mamas M. P681Acute Myocardial Infarction in patients with Leukaemia: A national analysis of prevalence, predictors and outcomes in United States hospitalisations (2004 to 2014). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with leukaemia are at increased risk of cardiovascular events. There is limited outcomes data for patients with a history of leukaemia who present with an acute myocardial infarction (AMI).
Purpose
To examine the prevalence and clinical characteristics of patients with leukaemia presenting with AMI, and evaluate differences in clinical outcomes according to the subtype of leukaemia in comparison to patients without leukaemia.
Methods
We analysed the Nationwide Inpatient Sample (2004–2014) for patients with a primary discharge diagnosis of AMI and concomitant leukaemia, and further stratified according to the subtype of leukaemia into 4 groups; AML; ALL; CML; and CLL. Multiple logistic regression was conducted to identify the association between leukaemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding.
Results
Out of 6,750,927 AMI admissions, a total of 21,694 patients had a leukaemia diagnosis. The leukaemia group experienced higher rates of MACCE (11.8% vs. 7.8%), mortality (10.3% vs. 5.8%) and bleeding (5.6% vs. 5.3%). Following adjustments, leukaemia was independently associated with increased odds of MACCE (OR 1.26 [1.20,1.31]) and mortality (OR 1.43 [1.37,1.50]) without an increased risk of bleeding (OR 0.86 [0.81,0.92]). Acute myeloid leukaemia (AML) was associated with approximately three-fold risk of MACCE (RR 2.81 [2.51, 3.13]) and a four-fold risk of mortality (RR 3.75 [3.34, 4.22]) (Figure 1). Patients with leukaemia were less likely to undergo coronary angiography (CA) (48.5% vs. 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs. 42.9%) compared to those without leukaemia.
Figure 1.Relative risk of adverse events
Conclusion
Patients with leukaemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared to those without leukaemia. A multi-disciplinary approach between cardiologists and haematology oncologists may improve the outcomes of patients with leukaemia after AMI.
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Affiliation(s)
- M O Mohamed
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - J C Lopez-Mattei
- University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - C A Iliescu
- University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - P Purwani
- Loma Linda University Medical Center, Cardiology, Loma Linda, United States of America
| | - A Bharadwaj
- Loma Linda University Medical Center, Cardiology, Loma Linda, United States of America
| | - P Y Kim
- University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - N L Palaskas
- University of Texas MD Anderson Cancer Center, Cardiology, Houston, United States of America
| | - M Rashid
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - J E Potts
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - C S Kwok
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
| | - M Gulati
- University of Arizona, Cardiology, Phoenix, Arizona, United States of America
| | - A B Al Zubaidi
- Al Mafraq Hospital, Cardiology, Abu Dhabi, United Arab Emirates
| | - M Mamas
- Keele University, Cardiovascular Research Group, Keele, United Kingdom
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21
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Menown IBA, Mamas M, Cotton J, Hildick-Smith D, Eberli F, Leibundgut G, Tresukosol D, Macaya C, Stoll H, Sadozai S. P2807Clinical outcomes with cobalt chromium biolimus eluting drug-eluting stents compared with stainless steel biolimus eluting drug-eluting stents in all-comers patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Thinner stent struts may improve deliverability, conformability and reduce vessel injury. We report the first clinical outcomes of the thinner strut (84–88um) cobalt chromium biolimus eluting stent from the Biomatrix Alpha registry and compare these with objective performance criteria from the stainless steel BioMatrix Flex arm of the Leaders study.
Methods
A total of 1257 patients were studied: 400 patients from 12 centres receiving ≥1 Biomatrix Alpha stent were prospectively enrolled into the Biomatrix Alpha registry and then underwent a pre-specified comparison with 857 patients who received a Biomatrix Flex stent in the Leaders study. The primary endpoint was major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction (MI) or clinically driven target vessel revascularization (TVR) at 9 months. Assuming a 9.2% event rate with BioMatrix Flex, a one-sided type I error (α) of 0.05, and a 4% non-inferiority margin, a sample size of 400 in the Biomatrix alpha registry had >80% power to conclude non-inferiority.
Results
Baseline characteristics in the Alpha registry were typical of an all-comers population with a mean age of 64.7±11.3, diabetes 19%, current smoking 21%, dyslipidemia 57%, hypertension 57%, total stent length per lesion 25.49±13.45, mean stents per procedure 1.59±0.88 and overlapping stents in 13.4%. Observed MACE at 9 months with Alpha was 3.94% (upper limit 5.98%) vs. 9.28% MACE rate with Flex stents in Leaders, which met pre-specified criteria for non-inferiority (p<0.001) and on post hoc testing for superiority yielded p<0.001 for Alpha vs Flex. Secondary endpoints with Alpha included clinically-driven TVR 2.6%, all-cause mortality rate 1.51% and definite/probable stent thrombosis 0.25%.
While both Alpha and Leaders enrolled all-comers, Alpha included longer total stent length per lesion (25.49 vs 23.85mm, p<0.001) and more stents per procedure (mean 1.59 vs 1.34; p<0.001) but fewer patients with diabetes (19% vs 26%; p=0.0087), dyslipidemia (57 vs 65%; p=0.0037), prior MI (18.8% vs 32.2%; p<0.001) or acute coronary syndrome (41% vs 55%; p<0.001). To correct for these imbalances and to assess robustness further, a propensity score at the patient level data was undertaken (total sample size of 1257 patients; 400 from the Alpha registry and 857 from the LEADERS study). A propensity score stratification method was used obtaining 5 quintiles for adjusted analysis (each of the 5, containing 251 or 252 patients, 20%). In each of the strata as well as at the aggregate level, a p valve<0.005 was obtained confirming non-inferiority for the primary endpoint.
Conclusion
The thinner strut (84–88um) cobalt chromium Biomatrix Alpha stent demonstrated low MACE rates at 9 months which were non-inferior to MACE outcomes with the stainless steel Biomatrix Flex in the Leaders study. The robustness of this finding was further confirmed by a propensity score analysis.
Acknowledgement/Funding
Biosensors
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Affiliation(s)
- I B A Menown
- Craigavon Cardiac Centre, Craigavon, United Kingdom
| | - M Mamas
- University Hospitals of North Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - J Cotton
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - D Hildick-Smith
- Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - F Eberli
- Triemli Hospital, Zurich, Switzerland
| | | | | | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
| | - H Stoll
- Biosensors, Morges, Switzerland
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22
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Zghebi SS, Panagioti M, Rutter MK, Ashcroft DM, van Marwijk H, Salisbury C, Chew-Graham CA, Buchan I, Qureshi N, Peek N, Mallen C, Mamas M, Kontopantelis E. Assessing the severity of Type 2 diabetes using clinical data-based measures: a systematic review. Diabet Med 2019; 36:688-701. [PMID: 30672017 DOI: 10.1111/dme.13905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 01/11/2023]
Abstract
AIMS To identify and critically appraise measures that use clinical data to grade the severity of Type 2 diabetes. METHODS We searched MEDLINE, Embase and PubMed between inception and June 2018. Studies reporting on clinical data-based diabetes-specific severity measures in adults with Type 2 diabetes were included. We excluded studies conducted solely in participants with other types of diabetes. After independent screening, the characteristics of the eligible measures including design and severity domains, the clinical utility of developed measures, and the relationship between severity levels and health-related outcomes were assessed. RESULTS We identified 6798 studies, of which 17 studies reporting 18 different severity measures (32 314 participants in 17 countries) were included: a diabetes severity index (eight studies, 44%); severity categories (seven studies, 39%); complication count (two studies, 11%); and a severity checklist (one study, 6%). Nearly 89% of the measures included diabetes-related complications and/or glycaemic control indicators. Two of the severity measures were validated in a separate study population. More severe diabetes was associated with increased healthcare costs, poorer cognitive function and significantly greater risks of hospitalization and mortality. The identified measures differed greatly in terms of the included domains. One study reported on the use of a severity measure prospectively. CONCLUSIONS Health records are suitable for assessment of diabetes severity; however, the clinical uptake of existing measures is limited. The need to advance this research area is fundamental as higher levels of diabetes severity are associated with greater risks of adverse outcomes. Diabetes severity assessment could help identify people requiring targeted and intensive therapies and provide a major benchmark for efficient healthcare services.
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Affiliation(s)
- S S Zghebi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - M Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - M K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, Manchester
| | - D M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - H van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton
| | - C Salisbury
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, Bristol
| | - C A Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire
| | - I Buchan
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Health eResearch Centre, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool
| | - N Qureshi
- Primary Care Stratified Medicine (PriSM) group, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham
| | - N Peek
- Health eResearch Centre, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester
| | - C Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire
| | - M Mamas
- Keele Cardiovascular Research group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - E Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
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Lawson CA, Testani JM, Mamas M, Damman K, Jones PW, Teece L, Kadam UT. Chronic kidney disease, worsening renal function and outcomes in a heart failure community setting: A UK national study. Int J Cardiol 2018; 267:120-127. [PMID: 29957251 PMCID: PMC6024224 DOI: 10.1016/j.ijcard.2018.04.090] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/06/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Routine heart failure (HF) monitoring and management is in the community but the natural course of worsening renal function (WRF) and its influence on HF prognosis is unknown. We investigated the influence of routinely monitored renal decline and related comorbidities on imminent hospitalisation and death in the HF community population. METHODS A nested case-control study within an incident HF cohort (N = 50,114) with 12-years follow-up. WRF over 6-months before first hospitalisation and 12-months before death was defined by >20% reduction in estimated glomerular filtration rate (eGFR). Additive interactions between chronic kidney disease (CKD) and comorbidities were investigated. RESULTS Prevalence of CKD (eGFR<60 ml/min/1.73m2) in the HF community was 63%, which was associated with an 11% increase in hospitalisation and 17% in mortality. Both risk associations were significantly worse in the presence of diabetes. Compared to HF patients with eGFR,60-89, there was no or minimal increase in risk for mild to moderate CKD (eGFR,30-59) for both outcomes. Adjusted risk estimates for hospitalisation were increased only for severe CKD(eGFR,15-29); Odds Ratio 1.49 (95%CI;1.36,1.62) and renal failure(eGFR,<15); 3.38(2.67,4.29). The relationship between eGFR and mortality was U-shaped; eGFR, ≥90; 1.32(1.17,1.48), eGFR,15-29; 1.68(1.58,1.79) and eGFR,<15; 3.04(2.71,3.41). WRF is common and associated with imminent hospitalisation (1.50;1.37,1.64) and mortality (1.92;1.79,2.06). CONCLUSIONS In HF, the risk associated with CKD differs between the community and the acute HF setting. In the community setting, moderate CKD confers no risk but severe CKD, WRF or CKD with other comorbidities identifies patients at high risk of imminent hospitalisation and death.
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Affiliation(s)
- Claire A Lawson
- Leicester Diabetes Centre, Leicester University, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.
| | - J M Testani
- Yale University, New Haven, CT, United States
| | - M Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - K Damman
- University of Groningen, University Medical Center, Groningen, The Netherlands
| | - P W Jones
- Faculty of Medicine and Health Sciences, Keele University, England, UK
| | - L Teece
- Faculty of Medicine and Health Sciences, Keele University, England, UK
| | - U T Kadam
- Leicester Diabetes Centre, Leicester University, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Nagaraja V, Generaeux P, Cohen M, Suh W, Alasnag M, Potts J, Gunning M, Nolan J, Bagur R, Mamas M. P6029Impact of elixhauser comorbidity score on the outcomes of transcatheter aortic valve replacement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Nagaraja
- Prince of Wales Hospital, Cardiology, Sydney, Australia
| | - P Generaeux
- Morristown Medical Center, Cardiology, Morristown, United States of America
| | - M Cohen
- University of Miami Leonard M. Miller School of Medicine, Cardiology, Miami, United States of America
| | - W Suh
- University of California Los Angeles, Cardiology, Los Angeles, United States of America
| | - M Alasnag
- King Fahad Armed Forces Hospital, Cardiology, Jeddah, Saudi Arabia
| | - J Potts
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
| | - M Gunning
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
| | - J Nolan
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
| | - R Bagur
- London Health Sciences Centre, Department of Medicine, and Epidemiology & Biostatistics, London, Canada
| | - M Mamas
- University Hospital of North Staffordshire, Cardiology, Stoke On Trent, United Kingdom
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Shoaib A, Kinnaird T, Curzen N, Ludman P, Belder MD, Rashid M, Kwok CS, Nolan J, Zaman A, Mamas M. P3583Outcomes following percutaneous coronary intervention in Non-ST-segment elevation myocardial infarction patients with previous coronary artery bypass grafts surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3583] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Shoaib
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - T Kinnaird
- University Hospital of Wales, Cardiff, United Kingdom
| | - N Curzen
- University of Southampton, Southampton, United Kingdom
| | - P Ludman
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M D Belder
- James Cook University Hospital, Middlesborough, United Kingdom
| | - M Rashid
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - C S Kwok
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - J Nolan
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
| | - A Zaman
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - M Mamas
- Keele University, Keele Cardiovascular Research Group, Institute for Primary Care and Health Sciences, Keele, United Kingdom
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Rashid M, Potts J, Kwok C, Mohammed M, Shoaib A, Esnsor J, Ayyaz-Ul-Haq M, Nolan J, Mamas M. 5258Trends and outcomes of use of coronary angiography in management of non-ST-Elevation acute coronary syndromes (NSTEACS), a population based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5258] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Rashid
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - J Potts
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - C Kwok
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - M Mohammed
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - A Shoaib
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - J Esnsor
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - M Ayyaz-Ul-Haq
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - J Nolan
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
| | - M Mamas
- Keele University, 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Stoke On Trent, United Kingdom
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Anderson SG, Shoaib A, Myint P, Cleland J, Hardman SM, McDonagh T, Keavney B, Garratt CJ, Mamas M. P6545Does rhythm matter in acute heart failure? An insight into clinical outcomes from the British Society for Heart Failure national audit. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6545] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- S G Anderson
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
| | - A Shoaib
- University of Keele, Keele Cardiovascular Research Group, Keele, United Kingdom
| | - P Myint
- University of Aberdeen, Institute of Applied Health Sciences, Aberdeen, United Kingdom
| | - J Cleland
- University of Glasgow, Robertson Centre for Biostatistics and Clinical Trials, Glasgow, United Kingdom
| | - S M Hardman
- Whittington Hospital, Clinical & Academic Department of Cardiovascular Medicine, London, United Kingdom
| | - T McDonagh
- King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - B Keavney
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
| | - C J Garratt
- University of Manchester, Division of Cardiovascular Sciences, Manchester, United Kingdom
| | - M Mamas
- University of Keele, Keele Cardiovascular Research Group, Keele, United Kingdom
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Shoaib A, Mamas M, Thackray S, Uddin M, Perveen R, Khan R, McDonagh T, Dargie H, Hardman S, Clark A, Cleland J. P2460Furosemide versus bumetanide; a deep dive into national heart failure audit (England & Wales). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2460] [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: 11/12/2022] Open
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Satchithananda DK, Patwala A, Barker D, Dwivedi G, Mamas M. Concerns about latest NICE guidelines on acute heart failure. BMJ 2014; 349:g6707. [PMID: 25391216 DOI: 10.1136/bmj.g6707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - A Patwala
- Royal Stoke University Hospital, Stoke on Trent, UK
| | - D Barker
- Royal Stoke University Hospital, Stoke on Trent, UK
| | - G Dwivedi
- Ottawa Heart Institute, Ottawa, Canada
| | - M Mamas
- Manchester Royal Infirmary, Manchester, UK
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Tagney J, Palmer S, Morris M, Albarran JW, Lockyer L, Burchardt C, Hall G, Parslow J, Ernst S, Osman J, Kavanagh H, Dayer MJ, Quinton E, Clift P, Hudsmith L, Thorne S, de Bono J, Pounds G, Mumford SL, Jarman J, Brough CEP, McGee C, Rao A, Wright DJ, Brough CEP, McGee C, Rao A, Wright DJ, Ahmed FZ, Allen S, Mamas M, Zaidi AM, Cantor EJ, Carroz P, Schilling RJ, Barker D, Cullen D, Hall R, Ng Kam Chuen MJ, Hughes S, Sharpe A, Wright DJ, Rao A, Ng Kam Chuen MJ, Wright DJ, Hughes S, Belchambers S, Sendegaya M, Rao A. ABSTRACTS FOR ORAL PRESENTATION, SESSION 1, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Phan TT, Khan S, Dewhurst M, Lee D, James S, de Belder M, Linker NJ, Thornley A, Turley AJ, Ahmed FZ, Arumugam P, Allen S, Daniels K, Clarke B, Mamas M, James J, Zaidi AM, Ullah W, Hunter R, Lovell M, Dhinoja M, Earley M, Sporton S, Schilling R, Raju H, Hedley P, Arno G, Ware J, Jeffery S, Cook S, Christiansen M, Behr ER, Sohal M, Chen Z, Sammut E, Jackson T, Child N, Wright M, O'Neill M, Cooklin M, Gill J, Carr-White G, Razavi R, Rinaldi CA, Nunn LM, Lopes L, Syrris P, Plagnol V, Firman E, Dalageorgou C, Domingo D, Zorio E, Murday V, Findlay I, Duncan A, Fynn S, White A, Goddard M, Carr-White G, Robert L, Bueser T, Langman C, Bundgaard H, Ferrero-Miliani L, Wheeldon N, O'Beirne A, Suvarna SK, Lowe MD, McKenna WJ, Elliott PM, Lambiase PD. YOUNG INVESTIGATORS COMPETITION, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sastry S, Mamas M, Palmer K, Iles-Smith H, El-Omar M, Fraser D, Fath-Ordoubadi F. 031 Use of the novel sideguard dedicated bifurcation stent: a real world experience. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roberts E, Mamas M, Wood A, Fraser D, Stables R, Rodrigues E, Hudson I, Palmer N, Skehan D. GRACE risk recommendations in NICE CG94 are not appropriate. Heart 2011; 97:1279; author reply 1279-80. [DOI: 10.1136/heartjnl-2011-300405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hegab Z, Mohammed TMA, Neyses L, Mamas M. 74 Mechanistic Study for the role of advanced glycation end products in the development of diabetic heart failure. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dixit A, Nair S, Williams P, Wiper A, Clarke B, Deaton C, El-Omar M, Fraser D, Khattar R, Mahadevan V, Neyses L, Ordoubadi F, Mamas M. 37 Decrease in mace rates associated with drug eluting stent use in patients with diabetes undergoing PCI in large diameter coronary arteries. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tierney S, Deaton C, Mamas M, Rutter M, Gibson M, Neyses L. P89 Understanding barriers and enablers of physical activity among patients with heart failure: a systematic review of qualitative studies. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-5151(11)60102-3] [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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Tierney S, Deaton C, Elwers H, Sange C, Mamas M, Rutter M, Gibson M, Neyses L. 21 Physical activity as heart failure therapy: patient perspectives. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-5151(11)60095-9] [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: 11/16/2022]
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Tierney S, Deaton C, Mamas M, Rutter M, Gibson M, Neyses L. P89 Poster Understanding Barriers and Enablers of Physical Activity among Patients with Heart Failure: A Systematic Review of Qualitative Studies. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160102-3] [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] [Indexed: 11/27/2022]
Affiliation(s)
- S. Tierney
- University of Manchester, Manchester, United Kingdom
| | - C. Deaton
- University of Manchester, Manchester, United Kingdom
| | - M. Mamas
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Rutter
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Gibson
- University of Manchester, Manchester, United Kingdom
| | - L. Neyses
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Tierney S, Deaton C, Elwers H, Sange C, Mamas M, Rutter M, Gibson M, Neyses L. 21 Oral Physical activity as heart failure therapy: patient perspectives. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-51511160095-9] [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] [Indexed: 10/28/2022]
Affiliation(s)
- S. Tierney
- University of Manchester, Manchester, United Kingdom
| | - C. Deaton
- University of Manchester, Manchester, United Kingdom
| | - H. Elwers
- University Hospitals of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - C. Sange
- University of Manchester, Manchester, United Kingdom
| | - M. Mamas
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Rutter
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - M. Gibson
- University of Manchester, Manchester, United Kingdom
| | - L. Neyses
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Guldbrand D, Goetzsche O, Eika B, Watanabe N, Taniguchi M, Akagi T, Koide N, Sano S, Orbovic B, Obrenovic-Kircanski B, Ristic S, Soskic LJ, Alhabshan F, Jijeh A, Abo Remsh H, Alkhaldi A, Najm HK, Gasior Z, Skowerski M, Kulach A, Szymanski L, Sosnowski M, Wang M, Siu CW, Lee K, Yue WS, Yan GH, Lee S, Lau CP, Tse HF, O'connor K, Rosca M, Magne J, Romano G, Moonen M, Pierard LA, Lancellotti P, Floria M, De Roy L, Blommaert D, Jamart J, Dormal F, Lacrosse M, Arsenescu Georgescu C, Mizariene V, Bucyte S, Bertasiute A, Pociute E, Zaliaduonyte-Peksiene D, Baronaite-Dudoniene K, Sileikiene R, Vaskelyte J, Jurkevicius R, Dencker M, Thorsson O, Karlsson MK, Linden C, Wollmer P, Andersen LB, Catalano O, Perotti MR, Colombo E, De Giorgi M, Cattaneo M, Cobelli F, Priori SG, Ober C, Iancu Adrian IA, Andreea Parv PA, Cadis Horatiu CH, Ober Mihai OM, Chmielecki M, Fijalkowski M, Galaska R, Dubaniewicz W, Lewicki L, Targonski R, Ciecwierz D, Puchalski W, Koprowski A, Rynkiewicz A, Hristova K, La Gerche A, Katova TZ, Kostova V, Simova Y, Kempny A, Diller GP, Orwat S, Kaleschke G, Kerckhoff G, Schmidt R, Radke RM, Baumgartner H, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Kiotsekoglou A, Govind SC, Gadiyaram V, Moggridge JC, Govindan M, Gopal AS, Ramesh SS, Brodin LA, Saha SK, Ramzy IS, Lindqvist P, Lam YY, Duncan AM, Henein MY, Craciunescu IS, Serban M, Iancu M, Revnic C, Popescu BA, Alexandru D, Rogoz D, Uscatescu V, Ginghina C, Careri G, Di Monaco A, Nerla R, Tarzia P, Lamendola P, Sestito A, Lanza GA, Crea F, Giannini F, Pinamonti B, Santangelo S, Perkan A, Vitrella G, Rakar S, Merlo M, Della Grazia E, Salvi A, Sinagra G, Scislo P, Kochanowski J, Piatkowski R, Roik M, Postula M, Opolski G, Castillo J, Herszkowicz N, Ferreira C, Lonnebakken MT, Staal EM, Nordrehaug JE, Gerdts E, Przewlocka-Kosmala M, Orda A, Karolko B, Bajraktari G, Lindqvist P, Gustafsson U, Holmgren A, Henein MY, Frattini S, Faggiano P, Zilioli V, Locantore E, Longhi S, Bellandi F, Faden G, Triggiani M, Dei Cas L, Seo SM, Jung HO, An SH, Jung SY, Park CS, Jeon HK, Youn HJ, Chung WB, Kim JH, Uhm JS, Mampuya W, Brochu MC, Do DH, Essadiqi B, Farand P, Lepage S, Daly MJ, Monaghan M, Hamilton A, Lockhart C, Kodoth V, Maguire C, Morton A, Manoharan G, Spence MS, Streb W, Mitrega K, Nowak J, Duszanska A, Szulik M, Kalinowski M, Kukulski T, Kalarus Z, Calvo Iglesias FE, Solla-Ruiz I, Villanueva-Benito I, Paredes-Galan E, Bravo-Amaro M, Iniguez-Romo A, Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Demiroglu IC, Aytekin S, Enache R, Piazza R, Muraru D, Roman-Pognuz A, Popescu BA, Calin A, Leiballi E, Antonini-Canterin F, Ginghina C, Nicolosi GL, Ridard C, Bellouin A, Thebault C, Laurent M, Donal E, Sutandar A, Siswanto BB, Irmalita I, Harimurti G, Saxena A, Ramakrishnan S, Roy A, Krishnan A, Misra P, Bhargava B, Poole-Wilson PA, Loegstrup BB, Andersen HR, Poulsen SH, Klaaborg KE, Egeblad HE, Gu X, Gu XY, He YH, Li ZA, Han JC, Chen J, Mansencal N, Mitry E, Rougier P, Dubourg O, Villarraga H, Adjei-Twum K, Cudjoe TKM, Clavell A, Schears RM, Cabrera Bueno F, Molina Mora MJ, Fernandez Pastor J, Linde Estrella A, Pena Hernandez JL, Isasti Aizpurua G, Carrasco Chinchilla F, Barrera Cordero A, Alzueta Rodriguez FJ, De Teresa Galvan E, Gaetano Contegiacomo GC, Francesco Pollice FP, Paolo Pollice PP, Gu X, Gu XY, He YH, Li ZA, Kontos MC, Shin DH, Yoo SY, Lee CK, Jang JK, Jung SI, Song SI, Seo SI, Cheong SS, Peteiro J, Perez-Perez A, Bouzas-Mosquera A, Pineiro M, Pazos P, Campo R, Castro-Beiras A, Gaibazzi N, Rigo F, Sartorio D, Reverberi C, Sitia S, Tomasoni L, Gianturco L, Ghio L, Stella D, Greco P, De Gennaro Colonna V, Turiel M, Sitia S, Tomasoni L, Cicala S, Magagnin V, Caiani E, Turiel M, Kyrzopoulos S, Tsiapras D, Domproglou G, Avramidou E, Voudris V, Wierzbowska-Drabik K, Lipiec P, Chrzanowski L, Roszczyk N, Kupczynska K, Kasprzak JD, Sachpekidis V, Bhan A, Gianstefani S, Reiken J, Paul M, Pearson P, Harries D, Monaghan MJ, Dale K, Stoylen A, Saha SK, Kodali V, Toole R, Govind SC, Moggridge JC, Kiotsekoglou A, Gopal AS, Raju P, Mcintosh RA, Silberbauer J, Baumann O, Patel NR, Sulke N, Trivedi U, Hyde J, Venn G, Lloyd G, Wejner-Mik P, Lipiec P, Wierzbowska K, Kasprzak JD, Lowenstein JA, Caniggia C, Garcia A, Amor M, Casso N, Lowenstein Haber D, Porley C, Zambrana G, Daru V, Deljanin Ilic M, Ilic S, Kalimanovska Ostric D, Stoickov V, Zdravkovic M, Paraskevaidis I, Ikonomidis I, Parissis J, Papadopoulos C, Stasinos V, Bistola V, Anastasiou-Nana M, Gudin Uriel M, Balaguer Malfagon JR, Perez Bosca JL, Ridocci Soriano F, Martinez Alzamora N, Paya Serrano R, Ciampi Q, Pratali L, Della Porta M, Petruzziello B, Villari B, Picano E, Sicari R, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Sutherland GR, Bijnens B, Myrmel T, Andersen M, Gustafsson F, Secher NH, Brassard P, Jensen AS, Hassager C, Madsen PL, Moller JE, Mampuya W, Brochu MC, Coutu M, Do DH, Essadiqi B, Farand P, Greentree D, Normandin D, Lepage S, Brun H, Dipchand A, Koopman L, Fackoury CT, Truong S, Manlhiot C, Mertens L, Baroni M, Mariani M, Chabane HK, Berti S, Ripoli A, Storti S, Glauber M, Scopelliti PA, Antongiovanni GB, Personeni D, Saino A, Tespili M, Jung P, Mueller M, Jander F, Sohn HY, Rieber J, Schneider P, Klauss V, Agricola E, Slavich M, Stella S, Ancona M, Oppizzi M, Bertoglio L, Melissano G, Margonato A, Chiesa R, Cejudo Diaz Del Campo L, Mesa Rubio D, Ruiz Ortiz M, Delgado Ortega M, Villanueva Fernandez E, Lopez Aguilera J, Toledano Delgado F, Pan Alvarez-Ossorio M, Suarez De Lezo Cruz Conde J, Lafuente M, Butz T, Meissner A, Lang CN, Prull MW, Plehn G, Trappe HJ, Nair SV, Lee L, Mcleod I, Whyte G, Shrimpton J, Hildick Smith D, James PR, Slikkerveer J, Appelman YEA, Veen G, Porter TR, Kamp O, Colonna P, Ten Cate FJ, Bokor D, Daponte A, Cocciolo M, Bona M, Sacchi S, Becher H, Chai SC, Tan PJ, Goh YS, Ong SH, Chow J, Lee LL, Goh PP, Tong KL, Kakihara R, Naruse C, Hironaka H, Tsuzuku T, Ozawa K, Tomaszuk-Kazberuk A, Sobkowicz B, Malyszko J, Malyszko JS, Kalinowski M, Sawicki R, Hirnle T, Dobrzycki S, Mysliwiec M, Musial WJ, Mathias W, Kowatsch I, Saroute ALR, Osorio AFF, Sbano JCN, Ramires JAF, Tsutsui JM, Sakata K, Ito H, Ishii K, Sakuma T, Iwakura K, Yoshino H, Yoshikawa J, Shahgaldi K, Lopez A, Fernstrom B, Sahlen A, Winter R, Kovalova S, Necas J, Amundsen BH, Jasaityte R, Kiss G, Barbosa D, D'hooge J, Torp H, Szmigielski CA, Newton JD, Rajpoot K, Noble JA, Kerber R, Becher H, Koopman LP, Slorach C, Chahal N, Hui W, Sarkola T, Manlhiot C, Bradley TJ, Jaeggi ET, Mccrindle BW, Mertens L, Staron A, Gasior Z, Jasinski M, Wos S, Sengupta P, Wierzbowska-Drabik K, Chrzanowski L, Kasprzak JD, Hayat D, Kloeckner M, Nahum J, Dussault C, Dubois Rande JL, Gueret P, Lim P, King GJ, Brown A, Ho E, Amuntaser I, Bennet K, Mc Elhome N, Murphy RT, Cooper RM, Somauroo JD, Shave RE, Williams KL, Forster J, George C, Bett T, George KP, D'andrea A, Riegler L, Cocchia R, Golia E, Gravino R, Salerno G, Citro R, Caso PIO, Bossone E, Calabro' R, Crispi F, Bijnens B, Figueras F, Bartrons J, Eixarch E, Le Noble F, Ahmed A, Gratacos E, Shang Q, Yip WK, Tam LS, Zhang Q, Lam YY, Li CM, Wang T, Ma CY, Li KM, Yu CM, Dahlslett T, Helland I, Edvardsen T, Skulstad H, Magda LS, Florescu M, Ciobanu A, Dulgheru R, Mincu R, Vinereanu D, Luckie M, Chacko S, Nair S, Mamas M, Khattar RS, El-Omar M, Kuch-Wocial A, Pruszczyk P, Szmigielski CA, Szulc M, Styczynski G, Sinski M, Kaczynska A, Bajraktari G, Vela Z, Haliti E, Hyseni V, Olloni R, Rexhepaj N, Elezi S, Henein MY, Onaindia JJ, Quintana O, Cacicedo A, Velasco S, Alarcon JJ, Morillas M, Rumoroso JR, Zumalde J, Lekuona I, Laraudogoitia Zaldumbide E, Haliti E, Bajraktari G, Poniku A, Ahmeti A, Elezi S, Henein MY, Duncan RF, Mccomb JM, Pemberton J, Lord SW, Leong D, Plummer C, Macgowan G, Grubb N, Leung M, Kenny A, Prinz C, Voigt JU, Zaidi A, Heatley M, Abildstrom SZ, Hvelplund A, Berning J, Saha SK, Toole R, Govind S, Kiotsekoglou A, Brodin L, Gopal A, Castaldi B, Di Salvo G, Santoro G, Gaio G, Palladino MT, Iacono C, Pacileo G, Russo MG, Calabro R, Wang YS, Dong LL, Shu XH, Pan CZ, Zhou DX, Sen T, Tufekcioglu O, Ozdemir M, Tuncez A, Uygur B, Golbasi Z, Kisacik H, Delfino L, De Leo FD, Chiappa LC, Abdel Ghani B, Schiavina R, Salvade P, Morganti A, Bedogni F, Mahia P, Gutierrez L, Pineda V, Garcia B, Otaegui I, Rodriguez JF, Gonzalez MT, Descalzo M, Evangelista A, Garcia-Dorado D, Bruin De- Bon HACM, Van Den Brink RBA, Surie S, Bresser P, Vleugels J, Eckmann HM, Samson DA, Bouma BJ, Dedobbeleer C, Antoine M, Remmelink M, Unger P, Roosens B, Hmila I, Hernot S, Droogmans S, Van Camp G, Lahoutte T, Muyldermans S, Cosyns B, Feltes G, Serra V, Azevedo O, Barbado J, Herrera J, Rivera A, Paniagua J, Valverde V, Torras J, Arriba G, Christodoulides T, Ioannides M, Simamonian K, Yiangou K, Myrianthefs M, Nicolaides E, Dedobbeleer C, Pandolfo M, Unger P, Kleijn SA, Aly MFAA, Terwee CB, Van Rossum AC, Kamp O, Delgado V, Shanks M, Siebelink HM, Sieders A, Lamb H, Ajmone Marsan N, Westenberg J, De Roos A, Schuijf JD, Bax JJ, Anwar AM, Nosir Y, Chamsi-Pasha H, Tschernich HD, Seeburger J, Borger M, Mukherjee C, Mohr FW, Ender J, Obase K, Okura H, Yamada R, Miyamoto Y, Saito K, Imai K, Hayashida A, Watanabe N, Yoshida K. Poster session III * Friday 10 December 2010, 08:30-12:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nikolaidou T, Mamas M, Oceandy D, Neyses L. BAS/BSCR6 -Ketoglutarate: biological effects of a novel biomarker of heart failure. Heart 2010. [DOI: 10.1136/hrt.2010.205781.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Samuel J, Schaub M, Zaugg M, Mamas M, Dunn W, Swynghedauw B. Genomics in cardiac metabolism. J Mol Cell Cardiol 2008. [DOI: 10.1016/j.yjmcc.2008.02.230] [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: 10/22/2022]
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Abstract
STUDY DESIGN Literature review of current treatment options for detrusor-sphincter dyssynergia (DSD) in spinal cord injury. OBJECTIVES To review the outcomes and complications associated with external sphincterotomy and to summarise the results and complications of alternative treatment options for detrusor-sphincter dyssynergia in spinal cord injury. In addition, we propose a potential alternative future drug treatment for external sphincter dyssynergia based upon recent research on the neuropharmacology of the external urethral sphincter. SETTING The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. METHODS Medline search from 1966 to 2002 using the words 'external sphincterotomy', 'detrusor-sphincter dyssynergia' and 'neurogenic bladder combined with surgery'. RESULTS While external sphincterotomy is an effective treatment for DSD, a significant number of men following this procedure continue to have high intrarenal pressures, recurrent urinary infection or troublesome autonomic dysreflexia and a worryingly high proportion demonstrate persistently raised leak point pressures, putting them at subsequent risk of renal damage. Alternative treatments for external sphincter dyssynergia include urethral stents and balloon dilatation, both of which are effective. However, over the long term stents can undergo encrustation and there remains a definite risk of stent migration necessitating stent removal or replacement. Balloon dilatation of the external sphincter is associated with a risk of subsequent stricture formation. Intraurethral Botulinum A toxin seems to be effective though there have been no large randomised studies comparing it against placebo. However, it is not a durable treatment option and it has not found a common place in the treatment of DSD. There is now a considerable amount of experimental data from both animal and human studies to suggest that nitric oxide (NO) is an important physiological inhibitory neurotransmitter in the urethral sphincter, mediating relaxation of the external urethral sphincter. The potential role of sphincter NO augmentation for treatment of DSD is discussed. CONCLUSION External sphincterotomy remains the mainstay of treatment for urodynamically significant detrusor-sphincter dyssynergia, but in recent years a number of effective, alternative treatment options have become available. While at present there is no effective systemic drug treatment, recent research into external sphincter neuropharmacology suggests that systemic or topical augmentation of external sphincter NO may provide an effective method for lowering sphincter pressure.
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Affiliation(s)
- J M Reynard
- The National Spinal Injuries Centre, Stoke Mandeville Hospital, UK
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