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Senguttuvan NB, Singh H, Kumar BV, Kongara RC, Abdulkader RS, Anandaram A, Krishnamurthy P, Balasubramaniyan JV, Sadhanandham S, Ramesh S, Manokar P, Muralidharan TR, Murthy JSN, Thanikachalam S. Safety and Efficacy of OPN Balloon in Patients With Calcified Coronary Artery Disease. Cardiovasc Revasc Med 2023; 54:25-30. [PMID: 36842933 DOI: 10.1016/j.carrev.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Patients with symptomatic calcified coronary lesions have poor outcomes. Such lesions require additional atherectomy devices for bed preparation. AIM To assess the safety and efficacy of OPN balloon in patients with calcified coronary lesions. METHODS This is an investigator-initiated, prospective, observational study. The primary outcome of the study was a procedural success. RESULTS We studied 71 patients (133 lesions). Maximum lesions were located in LAD [46.6 %]. The OPN balloon was used for pre-dilatation alone in 28.6 % (Pre-stent OPN group), post-dilatation alone in 63.2 % of lesions (Post-stent OPN group), and in both situations in 8.3 % of lesions with procedural success in 98.5 % of patients. Further dilatation with different NC balloons was required in both groups (30 %). The median (IQR) OPN balloon diameter in the pre- and post-stent OPN group were 2.5 (2.5, 3.0) and 3.0 (3.0,3.0) mm (p = 0.001), respectively. The difference between the diameter of the stent and OPN balloon used in pre-stent OPN group was 0.5 (0.2, 0.5) mm while it was 0.0 (0.0,0.2) mm in the post-stent OPN group (p < 0.001). Eight complications and two deaths occured. Distal shaft rupture was also noticed. CONCLUSION OPN balloon is safe, and effective in treating calcified coronary lesions. We propose to undersize the balloon by 0.5 mm for pre-dilatation followed by 0.25 mm larger NC balloon if needed. In the post-dilatation group, use a 1:1 size balloon in a non-tortuous straight segment. Use imaging especially when (1) the pressure taken more than the rated burst pressure, (2) an OPN balloon size is ≥3 mm (3) using 1:1 size OPN balloon in a tortuous segment.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Harsimran Singh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Rahul Chowdary Kongara
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | | | - Asuwin Anandaram
- Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy Venkata Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Shanmugasundram Sadhanandham
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Thoddi Ramamurthy Muralidharan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy S N Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
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Ramamurthy MT, Balakrishnan VK, Vallivedu MV, Senguttuvan NB, Manokar P, Sankaran R, Sadhanandham S, Balasubramaniyan JV, Rathinasamy J, Krishnamurthy P, Sundaram S, Murthy JSS, Thanikachalam S, Pogwizd S, Hoidal JR, Namakkal-Soorappan R. Improved Diagnosis through Diastolic Hyperemia-Free Ratio (DFR) over Fractional Flow Reserve (FFR) in Intermediate Coronary Lesions. Cardiol Cardiovasc Med 2023; 7:108-116. [PMID: 37554658 PMCID: PMC10409495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVES To compare the fractional flow reserve (FFR) and diastolic hyperemia-free ratio (DFR) measurements in a population with intermediate coronary artery stenosis and improve the diagnosis. BACKGROUND Visual assessment of coronary artery stenosis severity, particularly in intermediate lesions, is prone to errors in decision-making. FFR provides a reliable assessment of functional severity in these cases but requires hyperemia induction by adenosine, which has side effects and increased cost. DFR is a novel hyperemia-independent index, which could be used as an alternative to adenosine-based hyperemia induction. METHODS AND RESULTS Between September 2019 to March 2020, 25 patients with 38 intermediate coronary stenotic lesions were included in the study. All patients underwent assessment of whole cycle Pd/Pa (ratio of distal coronary pressure to proximal aortic pressure), DFR and FFR. Mean whole cycle Pd/Pa, DFR and FFR were 0.93±0.06, 0.88±0.09, and 0.85±0.08, respectively. A significant positive correlation between DFR and FFR [r = 0.74; p<0.001] was observed. Receiver operating characteristic analysis showed an area under the curve of 0.90. DFR-only strategy with a treatment cut-off of ≤0.89 showed a diagnostic agreement with the FFR-only strategy in 74% of lesions, with a sensitivity of 54%, specificity of 82%, a positive predictive value of 60%, and a negative predictive value of 79%. CONCLUSIONS Real-time DFR measurements show a clinically reliable correlation with FFR. Hence, using DFR is likely to avoid adenosine administration as well as reduce the cost and procedural time. Further studies with a larger sample size would be ideal to evaluate specific cut-off values and endpoints.
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Affiliation(s)
| | - Vinod Kumar Balakrishnan
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | - Mano Vikash Vallivedu
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | | | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | - Ramesh Sankaran
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | | | | | - Jebaraj Rathinasamy
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | - Sandhya Sundaram
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | | | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India
| | - Steven Pogwizd
- Comprehensive Cardiovascular Center, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John R. Hoidal
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Rajasekaran Namakkal-Soorappan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
- Center for Free Radical Biology, Department of Pathology University of Alabama at Birmingham, Birmingham, AL, USA
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Senguttuvan NB, Kongara R, Sadhanandham S, Srinivasan NV, Periyasamy SK, Vinod Kumar B, Shankar P R, Iyer M, Ramadoss M, Subramanian V, Venkata Balasubramaniyan J, Krishnamurthy P, Ramesh S, Manokar P, Muralidharan TR, Murthy JS, Thanikachalam S. Procedural Safety and Long-Term Clinical Outcomes in Patients Receiving Ultra-Long Everolimus-Eluting Stent: A Single-Center Real-World Experience. Cardiol Res 2022; 13:104-109. [PMID: 35465083 PMCID: PMC8993437 DOI: 10.14740/cr1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Diffuse long coronary lesions are difficult to treat percutaneously. The aim of the present study was to assess the procedural safety and long-term efficacy of the ultra-long (48-mm) drug-eluting stent Xience Xpedition. Methods This was an investigator-initiated, observational, all-comers study. A total of 92 patients with 93 lesions were enrolled in the study from October 2016 to October 2020. The primary outcome of the study was major adverse cardiac events (MACEs). Secondary outcomes were individual components of the primary outcome and procedural success. Results The mean (standard deviation (SD)) age of the participants was 58.8 (10.8) years. More than half of the patients had ST-segment elevation myocardial infarction (STEMI) at presentation (55.4%). Ten patients were in cardiogenic shock (CGS; 10.8%). Most of the lesions were located in the left anterior descending artery (48.3%). American College of Cardiology/American Heart Association (ACC/AHA) type C was the most common lesion type amongst the intervened vessels (46.74%), with a mean syntax score (SD) of 16.99 (8.89). The mean stent diameter used was 2.77 mm (0.25). MACE was observed in 7.6% of patients studied at a median follow-up of 24 months. MACE was significantly lower in the population without CGS, occurring in only 2.4% of the patients; a significant difference in MACE was observed in patients with and without CGS (P < 0.001). Procedural success was obtained in 89.2% of total population; however, 96.3% of patients without CGS had procedural success. Conclusions The deployment of the ultra-long 48-mm Xience Xpedition stent is feasible, safe, and effective; and it was associated with a good intermediate-term clinical outcome.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
- Adjunct Faculty, Department of Engineering and Design, Indian Institute of Technology-Madras, Chennai, India
- These authors contributed equally to this article
- Corresponding Author: Nagendra Boopathy Senguttuvan, Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.
| | - Rahul Kongara
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
- These authors contributed equally to this article
| | - Shanmugasundram Sadhanandham
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Nishok Victory Srinivasan
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Santhosh Kumar Periyasamy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Ravi Shankar P
- Department of Statistics, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Meena Iyer
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Mahalakshmi Ramadoss
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Vinodhini Subramanian
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy Venkata Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Thoddi Ramamurthy Muralidharan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthi Sathyanarayana Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu 600116, India
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Jayagopal P, Sastry SL, Nanjappa V, Abdullakutty J, Joseph J, Vaidyanathan P, Kabra N, Manokar P, Ghanta SS, Sharma V, Mishra TK, Jathappa N, Singh V, Routray S, Mandal S, Bhalla N, Dorairaj P, Mehta N, Kumbla D, Rane AR, Matia TK, Jain D, Rege G, Modi S, Chopra V, Mohanan P, Geevar Zachariah A, Ravindranath K, Chakraborty R, Srinivas B, Raghu T, Manjunath C. Clinical characteristics and 30-day outcomes in patients with acute decompensated heart failure: Results from Indian College of Cardiology National Heart Failure Registry (ICCNHFR). Int J Cardiol 2022; 356:73-78. [DOI: 10.1016/j.ijcard.2022.03.021] [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] [Received: 10/04/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 11/05/2022]
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Kongara R, Sankaran RAMESH, Muralidharan TR, Manokar P, Sadhanandham S, Nagendra Boopathy S, Vinod Kumar B, Balasubramaniyan JV, Preetham K. Demographic analysis and clinical outcomes of COVID-19 and myocardial infarction from a tertiary care centre in south India. Eur Heart J 2022. [PMCID: PMC9383399 DOI: 10.1093/eurheartj/ehab849.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Back ground – COVID-19 is reported in India from March 2020. It is known to cause myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction. PURPOSE –We intent to study outcomes of acute coronary syndrome associated with COVID-19 patients . METHODS – This is a single center case-control study done in an University hospital in south India , from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without COVID -19 in the same period. RESULITS – 508 patients were admitted between May 2020 to October 2020 with ACS and out of which 58 patients were positive for COVID-19 and 450 patients were COVID-19 negative. In COVID positive group, most of the patients were above 50 years with 17 % of them being female sex. 60 % were having diabetes and 44.8 % had hypertension . 55% of them had STEMI with the rest being NSTE- ACS . 43.1 % patients were thrombolysed . 25% patients underwent revascularization either with PCI / CABG . 10.3% died in the COVID - 19 positive group , at the same time there were only 2.2 % deaths in the control group . Most the patients were asymptomatic COVID-19 at presentation . Among the symptomatic COVID-19 patients the onset of myocardial infarction after COVID-19 ranged from 9 – 90 days . CONCLUSION – Acute coronary syndrome in COVID-19 patients can present as late as 3 months after index infection, and these patients had higher mortality compared with those who did not have COVID -19 .
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Affiliation(s)
- R Kongara
- Sri Ramachandra University, Chennai, India
| | | | | | - P Manokar
- Sri Ramachandra University, Chennai, India
| | | | | | | | | | - K Preetham
- Sri Ramachandra University, Chennai, India
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Muralidharan TR, Ramesh S, Kumar BV, Ruia AV, Kumar M, Gopalakrishnan A, Johal GS, Hooda A, Malhotra R, Masoomi R, Ramadoss M, Subramanian V, Kalsingh MJ, Manokar P, Rathinasamy J, Sadhanandham S, Balasubramaniyan JV, Krishnamurthy P, Murthy JS, Thanikachalam S, Senguttuvan NB. Clinical profile and management of patients with acute pulmonary thromboembolism - a single centre, large observational study from India. Pulm Circ 2021; 11:2045894021992678. [PMID: 34104416 PMCID: PMC8164559 DOI: 10.1177/2045894021992678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 12/02/2022] Open
Abstract
Acute pulmonary thromboembolism is associated with high mortality, similar to
that of myocardial infarction and stroke. We studied the clinical presentation
and management of pulmonary thromboembolism in the Indian population. An
analysis of 140 patients who presented with acute pulmonary thromboembolism at a
large volume center in India from June 2015 through December 2018 was performed.
The mean age of our study population was 50 years with 59% being male.
Comorbidities including deep vein thrombosis, diabetes mellitus, hypertension,
and chronic obstructive pulmonary disease were present in 52.9%, 40%, 35.7% and
7.14% of patients, respectively. Out of 140 patients, 40 (28.6%) patients had
massive pulmonary thromboembolism, 36 (25.7%) sub-massive pulmonary
thromboembolism, and 64 (45.7%) had low-risk pulmonary thromboembolism. Overall,
in-hospital mortality was 25.7%. Multivariate regression analysis found chronic
kidney disease and pulmonary thromboembolism severity to be the only independent
risk factors. Thrombolysis was performed in 62.5% of patients with a massive
pulmonary thromboembolism and 63.9% of patients with a sub-massive pulmonary
thromboembolism. In the massive pulmonary thromboembolism group, patients
receiving thrombolytic therapy had lower mortality compared with patients who
did not receive therapy (p=0.022), whereas this difference was
not observed in patients in the sub-massive pulmonary thromboembolism group. We
conclude that patients with acute pulmonary thromboembolism in India presented
more than a decade earlier than our western counterparts, and it was associated
with poor clinical outcomes. Thrombolysis was associated with significantly
reduced in-hospital mortality in patients with massive pulmonary
thromboembolism.
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Affiliation(s)
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Aditya V Ruia
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Mohan Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | | | - Gurpreet S Johal
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Amit Hooda
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Rohit Malhotra
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Reza Masoomi
- Division of Interventional Cardiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Mahalakshmi Ramadoss
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Vinodhini Subramanian
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | | | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Jebaraj Rathinasamy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | | | - Jayanthy V Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Jayanthy S Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India
| | - Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.,Adjunct Faculty, Department of Engineering & Design Indian Institute of Technology (IIT-M) Chennai, Tamil Nadu
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Senguttuvan NB, Suman F, Paneerselvam T, Malepati B, Ramesh S, Vallivedu MV, Badimela P, Ramadoss M, Iyer M, Krishnamurthy P, Vinod Kumar B, Balasubramaniyan JV, Sadhanandham S, Jebaraj R, Manokar P, Muralidharan TR, Murthy JS, Thanikachalam S, Krishnamoorthy P, Baber U, Karthikeyan G. Comparison of the effect of Morphine and Fentanyl in patients with acute coronary syndrome receiving Ticagrelor - The COMET (Comparison Morphine, Fentayl and Ticagrelor) randomized controlled trial. Int J Cardiol 2021; 330:1-6. [PMID: 33600846 DOI: 10.1016/j.ijcard.2021.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome (ACS) management, and ticagrelor is one of the commonly used second antiplatelet agents. There is some evidence to suggest that morphine may reduce the antiplatelet effect of ticagrelor. METHODS AND RESULTS In a single-center, randomized controlled trial, we compared the effect of morphine and fentanyl on platelet aggregation (PA) among patients with ACS treated with ticagrelor. Platelet aggregation was studied by automated light transmittance aggregometry (LTA) at baseline, and at 2 h after ticagrelor loading. The primary outcome was the difference in the maximal inhibition of platelet aggregation [IPA(%)] between the groups at 2 h. Pain relief, and drug-related adverse events were secondary outcomes. Of 136 patients randomized, 70 received fentanyl and 66 received morphine. At baseline, the median (IQR) platelet aggregation [61.35% (54.6 to 70) Vs. 58.8% (52.7 to 72.9)] were comparable between the groups. There was no statistically significant difference between the fentanyl and the morphine groups in IPA at 2-h [85.88%(64.65-98.16) and 81.93%(44.2-98.03), p = 0.09]. However, morphine use was independently associated with a PA of >30% at 2 h (p < 0.009). There was no difference in adverse events. CONCLUSION In patients with ACS, there was no significant difference between the use of fentanyl or morphine on the effect of ticagrelor on PA. (CTRI/2018/04/013423).
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India; Adjunct Faculty, Department of Engineering and design, Indian Institute of Technology-Madras, Chennai, India.
| | - Febe Suman
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - TamilAnbu Paneerselvam
- Department of Emergency Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Balakrishna Malepati
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Mano Vikash Vallivedu
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Phalgun Badimela
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Mahalakshmi Ramadoss
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Meena Iyer
- Faculty of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy Venkata Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Shanmugasundram Sadhanandham
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Rathinasamy Jebaraj
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Thoddi Ramamurthy Muralidharan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy Sathyanarayana Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Parasuram Krishnamoorthy
- Division of Interventional Cardiology, Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York 10029, United States of America
| | - Usman Baber
- Division of Interventional cardiology, Cardiovascular Institute - Suite 2E, Oklahoma University, 825 N.E. 10th St., Oklahoma City, OK 73104, United States of America
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Chopra A, Nagarjuna G, Sundararaju P, Rangareddy B, Manokar P, Muralidharan T, Murthy JSN, Thanikachalam S. Isolated left ventricular noncompaction. Indian Heart J 2015. [DOI: 10.1016/j.ihj.2015.10.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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