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Vira A, Balanescu DV, George JA, Dixon SR, Hanson ID, Safian RD. Diagnostic Performance of Diastolic Hyperemia-Free Ratio Compared With Invasive Fractional Flow Reserve for Evaluation of Coronary Artery Disease. Am J Cardiol 2024; 214:55-58. [PMID: 38199309 DOI: 10.1016/j.amjcard.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/04/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
Hyperemic and nonhyperemic pressure ratios are frequently used to assess the hemodynamic significance of coronary artery disease and to guide the need for myocardial revascularization. However, there are limited data on the diagnostic performance of the diastolic hyperemia-free ratio (DFR). We evaluated the diagnostic performance of the DFR compared with invasive fractional flow reserve (FFR). We performed a prospective, single-center study of 308 patients (343 lesions) who underwent DFR and FFR for evaluation of visually estimated 40% to 90% stenoses. Diagnostic performance of the DFR compared with FFR was evaluated using linear regression, Bland-Altman analysis, and receiver operating characteristic curves. The overall diagnostic accuracy of the DFR was 83%; the accuracy rates were 86%, 40%, and 95% when the DFR was <0.86, 0.88 to 0.90, and >0.93, respectively. The sensitivity, specificity, positive predicative value, and negative predictive value were 60%, 91%, 71%, and 87%, respectively. The Pearson correlation coefficient was 0.75 (p <0.05). The Bland-Altman analysis showed a mean difference of 0.09, and the area under the receiver operating characteristic curve was 0.88 (95% confidence interval 0.84 to 0.92, p <0.05). In conclusion, the DFR has a good diagnostic performance compared with FFR but 17% of the measurements were discordant. The diagnostic accuracy of the DFR was only 40% when the DFR was 0.88 to 0.90, suggesting that FFR may be useful in these arteries.
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Affiliation(s)
- Amit Vira
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Dinu-Valentin Balanescu
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Julie A George
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Ivan D Hanson
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan
| | - Robert D Safian
- Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan.
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Hanson ID, Rusia A, Palomo A, Tawney A, Pow T, Dixon SR, Meraj P, Sievers E, Johnson M, Wohns D, Ali O, Kapur NK, Grines C, Burkhoff D, Anderson M, Lansky A, Naidu SS, Basir MB, O'Neill W. Treatment of Acute Myocardial Infarction and Cardiogenic Shock: Outcomes of the RECOVER III Postapproval Study by Society of Cardiovascular Angiography and Interventions Shock Stage. J Am Heart Assoc 2024; 13:e031803. [PMID: 38293995 PMCID: PMC11056148 DOI: 10.1161/jaha.123.031803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND The Society for Cardiovascular Angiography and Interventions proposed a staging system (A-E) to predict prognosis in cardiogenic shock. Herein, we report clinical outcomes of the RECOVER III study for the first time, according to Society for Cardiovascular Angiography and Interventions shock classification. METHODS AND RESULTS The RECOVER III study is an observational, prospective, multicenter, single-arm, postapproval study of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support. Patients enrolled in the RECOVER III study were assigned a baseline Society for Cardiovascular Angiography and Interventions shock stage. Staging was then repeated within 24 hours after initiation of Impella. Kaplan-Meier survival curve analyses were conducted to assess survival across Society for Cardiovascular Angiography and Interventions shock stages at both time points. At baseline assessment, 16.5%, 11.4%, and 72.2% were classified as stage C, D, and E, respectively. At ≤24-hour assessment, 26.4%, 33.2%, and 40.0% were classified as stage C, D, and E, respectively. Thirty-day survival among patients with stage C, D, and E shock at baseline was 59.7%, 56.5%, and 42.9%, respectively (P=0.003). Survival among patients with stage C, D, and E shock at ≤24 hours was 65.7%, 52.1%, and 29.5%, respectively (P<0.001). After multivariable analysis of impact of shock stage classifications at baseline and ≤24 hours, only stage E classification at ≤24 hours was a significant predictor of mortality (odds ratio, 4.8; P<0.001). CONCLUSIONS In a real-world cohort of patients with acute myocardial infarction with cardiogenic shock undergoing percutaneous coronary intervention with Impella support, only stage E classification at ≤24 hours was significantly predictive of mortality, suggesting that response to therapy may be more important than clinical severity of shock at presentation.
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Affiliation(s)
- Ivan D. Hanson
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Akash Rusia
- Department of Advanced Heart Failure, Baylor Scott & White Health–The Heart HospitalPlanoTX
| | - Andres Palomo
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Adam Tawney
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Timothy Pow
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | - Simon R. Dixon
- Department of Cardiovascular MedicineWilliam Beaumont University HospitalRoyal OakMI
| | | | - Eric Sievers
- Department of Cardiovascular SurgeryJackson‐Madison County HospitalJacksonTN
| | | | - David Wohns
- Division of CardiologySpectrum HealthGrand RapidsMI
| | - Omar Ali
- Department of CardiologyDetroit Medical CenterDetroitMI
| | - Navin K. Kapur
- Department of CardiologyTufts University School of MedicineBostonMA
| | - Cindy Grines
- Northside Hospital Cardiovascular InstituteAtlantaGA
| | | | - Mark Anderson
- Department of Cardiac SurgeryHackensack University Medical CenterHackensackNJ
| | | | - Srihari S. Naidu
- Department of CardiologyWestchester Medical Center and New York Medical CollegeValhallaNY
| | - Mir B. Basir
- Division of CardiologyHenry Ford HospitalDetroitMI
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Reinhold L, Lynch S, Lauter CB, Dixon SR, Aneese A. A Heart Gone Bananas: Allergy-Induced Coronary Vasospasm due to Banana (Kounis Syndrome). Case Reports Immunol 2023; 2023:5987123. [PMID: 37397346 PMCID: PMC10313452 DOI: 10.1155/2023/5987123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Abstract
Kounis syndrome encompasses a variety of cardiovascular signs and symptoms associated with mast cell activation in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It can manifest as coronary vasospasm, coronary, or in-stent thrombosis, and acute myocardial infarction with plaque rupture. Various medications as well as foods including fish, shellfish, mushroom, kiwi, and rice pudding have been implicated as causal agents. We present what we believe to be the first documented case of Kounis syndrome manifesting as coronary vasospasm as the result of an allergy to banana. This case highlights the importance of considering allergic causes of angina and allergy referral in a patient with known atopy and an otherwise negative cardiovascular workup. It also emphasizes to consider food allergy, especially banana, as a cause of Kounis syndrome.
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Affiliation(s)
| | - Stephen Lynch
- William Beaumont University Hospital, Royal Oak, MI, USA
| | - Carl B. Lauter
- William Beaumont University Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Simon R. Dixon
- William Beaumont University Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Andrew Aneese
- William Beaumont University Hospital, Royal Oak, MI, USA
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Mehta N, France J, Shah K, Kutinsky IB, Williamson BD, Goel AK, Dixon SR, Haines DE. BS-400-07 REDEFINE-EP: A PROSPECTIVE, RANDOMIZED EVALUATION OF THE CONTROLRAD SYSTEM TO REDUCE RADIATION EXPOSURE DURING CARDIAC ELECTRONIC IMPLANTABLE DEVICE PROCEDURES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1208] [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: 11/26/2022]
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Mehta N, France J, Shah K, Kutinsky IB, Williamson BD, Goel AK, Dixon SR, Haines DE. CI-523-03 REDEFINE-EP: A PROSPECTIVE, RANDOMIZED EVALUATION OF THE CONTROLRAD SYSTEM TO REDUCE RADIATION EXPOSURE DURING CARDIAC ELECTRONIC IMPLANTABLE DEVICE PROCEDURES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.109] [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: 11/27/2022]
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Aggarwal D, Bhatia K, Chunawala ZS, Furtado RHM, Mukherjee D, Dixon SR, Jain V, Arora S, Zelniker TA, Navarese EP, Mishkel GJ, Lee CJ, Banerjee S, Bangalore S, Levisay JP, Bhatt DL, Ricciardi MJ, Qamar A. P2Y 12 inhibitor versus aspirin monotherapy for secondary prevention of cardiovascular events: meta-analysis of randomized trials. Eur Heart J Open 2022; 2:oeac019. [PMID: 35919116 PMCID: PMC9242055 DOI: 10.1093/ehjopen/oeac019] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/13/2022] [Indexed: 12/24/2022]
Abstract
Aim To compare the efficacy and safety of P2Y12 inhibitor or aspirin monotherapy for secondary prevention in patients with atherosclerotic cardiovascular disease (ASCVD). Methods and results Medline, Embase, and Cochrane Central databases were searched to identify randomized trials comparing monotherapy with a P2Y12 inhibitor versus aspirin for secondary prevention in patients with ASCVD (cardiovascular, cerebrovascular, or peripheral artery disease). The primary outcome was major adverse cardiac events (MACE). Secondary outcomes were myocardial infarction (MI), stroke, all-cause mortality, and major bleeding. A random-effects model was used to calculate risk ratios (RR) and the corresponding 95% confidence interval (CI) and heterogeneity among studies was assessed using the Higgins I2 value. A total of 9 eligible trials (5 with clopidogrel and 4 with ticagrelor) with 61 623 patients were included in our analyses. Monotherapy with P2Y12 inhibitors significantly reduced the risk of MACE by 11% (0.89, 95% CI 0.84-0.95, I2 = 0%) and MI by 19% (0.81, 95% CI 0.71-0.92, I2 = 0%) compared with aspirin monotherapy. There was no significant difference in the risk of stroke (0.85, 95% CI 0.73-1.01), or all-cause mortality (1.01, 95% CI 0.92-1.11). There was also no significant difference in the risk of major bleeding with P2Y12 inhibitor monotherapy compared with aspirin (0.94, 95% CI 0.72-1.22, I2 = 42.6%). Results were consistent irrespective of the P2Y12 inhibitor used. Conclusion P2Y12 inhibitor monotherapy for secondary prevention is associated with a significant reduction in atherothrombotic events compared with aspirin alone without an increased risk of major bleeding.
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Affiliation(s)
- Devika Aggarwal
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Kirtipal Bhatia
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA
| | | | - Remo H M Furtado
- Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,Instituto do Coracao, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | - Debabrata Mukherjee
- Division of Cardiology, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas A Zelniker
- Division of Cardiology, Vienna General Hospital and Medical University of Vienna, Austria
| | - Eliano P Navarese
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Gregory J Mishkel
- Division of Cardiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Cheong J Lee
- Division of Vascular Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | | | - Sripal Bangalore
- Department of Medicine (Cardiology), New York University Grossman School of Medicine, New York, NY, USA
| | - Justin P Levisay
- Division of Cardiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Deepak L Bhatt
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Ricciardi
- Division of Cardiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Arman Qamar
- Division of Cardiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Dixon SR, Rabah M, Emerson S, Schultz C, Madder RD. A novel catheterization laboratory radiation shielding system: Results of pre-clinical testing. Cardiovasc Revasc Med 2021; 36:51-55. [PMID: 34052128 DOI: 10.1016/j.carrev.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND This pre-clinical study evaluated the efficacy of a novel shielding system to reduce scatter radiation in the cardiac catheterization laboratory. METHODS Using a scatter radiation phantom in a standard cardiac catheterization laboratory, a radiation physicist recorded radiation measurements at 20 reference points on the operator side of the table. Measurements were made with fluoroscopy and cine with the C-arm in the posterior-anterior (PA) and 40 degrees left anterior oblique (LAO) orientations. Scatter radiation doses were compared with and without use of the shielding system. RESULTS Use of the shielding system was associated with >94.2% reduction in scatter radiation across all reference points in the PA and LAO projections with fluoroscopy and cine. With the shielding system, dose reductions at the location of the primary operator ranged from 97.8% to 99.8%. At locations of maximum scatter radiation, use of the shielding system resulted in dose reductions ranging from 97.8% to 99.8% with fluoroscopy and from 97.9% to 99.8% with cine. CONCLUSIONS In this pre-clinical study, a novel radiation shielding system was observed to dramatically reduce scatter radiation doses. Based on these results, clinical testing is warranted to determine whether the shielding system will enable operators and staff to perform interventional procedures with less radiation exposure that may obviate the need to wear standard lead apparel. INDEXING WORDS Radiation safety; occupational health; occupational hazard.
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Affiliation(s)
- Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America.
| | - Maher Rabah
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America
| | - Scott Emerson
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America
| | - Cheryl Schultz
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, United States of America
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, United States of America
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8
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Sutton NR, Seth M, Madder RD, Sukul D, Dixon SR, Cannon LA, Gurm HS. Comparative Safety of Bioabsorbable Polymer Everolimus-Eluting, Durable Polymer Everolimus-Eluting, and Durable Polymer Zotarolimus-Eluting Stents in Contemporary Clinical Practice. Circ Cardiovasc Interv 2021; 14:e009850. [PMID: 33626898 DOI: 10.1161/circinterventions.120.009850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Nadia R Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (N.R.S., M.S., D.S., H.S.G.)
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (N.R.S., M.S., D.S., H.S.G.)
| | - Ryan D Madder
- Division of Cardiology, Spectrum Health, Grand Rapids, MI (R.D.M.)
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (N.R.S., M.S., D.S., H.S.G.)
- Department of Medicine, Section of Cardiology, Veterans Affairs Medical Center, Ann Arbor, MI (D.S., H.S.G.)
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI (S.R.D.)
| | - Louis A Cannon
- Cardiac and Vascular Research Center of Northern Michigan, Petoskey (L.A.C.)
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (N.R.S., M.S., D.S., H.S.G.)
- Department of Medicine, Section of Cardiology, Veterans Affairs Medical Center, Ann Arbor, MI (D.S., H.S.G.)
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9
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Schott JP, Dixon SR, Goldstein JA. Disparate impact of severe aortic and mitral regurgitation on left ventricular dilation. Catheter Cardiovasc Interv 2021; 97:1301-1308. [PMID: 33471957 DOI: 10.1002/ccd.29455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 12/27/2020] [Indexed: 11/11/2022]
Abstract
In asymptomatic severe aortic (AR) and mitral regurgitation (MR), left ventricular (LV) dimension criteria were established to guide timing of valve replacement to prevent irreversible LV dysfunction. Given both lesions are primary LV volume overload ''leaks'', it might be expected that both lesions would induce similar impact on the LV and result in equivalent dimension criteria for intervention. However, the dimension-based intervention criteria for AR versus MR (developed through natural history studies), differ markedly. The pathophysiological foundations for such discordance have neither been fully elucidated nor emphasized. This case-based treatise compares the two regurgitant lesions with respect to: (a) ''total regurgitant circuits''; (b) ''driving pressures'' resulting in LV volume overload from each respective ''leak''; and (c) volume and afterload wall stresses imposed on the LV.Key points The ''total circuits'' of volume overload differ: The AR circuit includes the LV and systemic vasculature, whereas MR includes the LV ejecting into the left atrium/pulmonary veins and systemic circulation. The ''driving pressure'' of regurgitation and afterload are high with AR and low with MR. Differing ''total circuits'' and ''driving pressures'' impose disparate wall stresses upon the LV. Parallel and serial sarcomere replication occurs in AR, while only serial replication occurs in MR. It therefore follows that for regurgitation of similar severities, AR results in greater LV dilation at the point of irreversible myocardial dysfunction compared to MR. These considerations may explain, at least in part, the disparate dimension criteria employed for valve intervention for severe AR vs MR.
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Affiliation(s)
- Jason P Schott
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA.,Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - James A Goldstein
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA.,Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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10
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Goldstein JA, Dixon SR. Mechanically supported PCI for ischemic cardiomyopathy reawakening of hibernating myocardium. Catheter Cardiovasc Interv 2020; 96:771-772. [PMID: 33085194 DOI: 10.1002/ccd.29304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
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Kadavath S, Mohan J, Ashraf S, Kassier A, Hawwass D, Madan N, Salehi N, Bernardo M, Mawri S, Rehman KA, Ya'qoub L, Strobel A, Dixon SR, Siraj A, Messenger J, Spears JR, Lopez-Candales A, Madder R, Bailey SR, Alaswad K, Kim MC, Safian RD, Alraies MC. Cardiac Catheterization Laboratory Volume Changes During COVID-19-Findings from a Cardiovascular Fellows Consortium. Am J Cardiol 2020; 130:168-169. [PMID: 32665133 PMCID: PMC7289082 DOI: 10.1016/j.amjcard.2020.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Sabeeda Kadavath
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jay Mohan
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan
| | - Said Ashraf
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
| | - Adnan Kassier
- Spectrum Health, Michigan State University, Frederik Meijer Heart & Vascular Institute, Grand Rapids, Michigan
| | - Dalia Hawwass
- Department of Cardiology, Lenox Hill Hospital, Northwell Health Medical Centers, New York, New York
| | - Nidhi Madan
- Department of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Negar Salehi
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Marie Bernardo
- Cardiology Division, Beaumont Hospital Dearborn, Dearborn, Michigan
| | - Sagger Mawri
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
| | | | - Lina Ya'qoub
- Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana
| | - Aaron Strobel
- Cardiology Division, University of Colorado, Aurora, Colorado
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan
| | - Aisha Siraj
- Cardiovascular Division, Case Western Reserve University/MetroHealth Medical Center Campus, Cleveland, Ohio
| | - John Messenger
- Cardiology Division, University of Colorado, Aurora, Colorado
| | - James R Spears
- Cardiology Division, Beaumont Hospital Dearborn, Dearborn, Michigan
| | - Angel Lopez-Candales
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ryan Madder
- Spectrum Health, Michigan State University, Frederik Meijer Heart & Vascular Institute, Grand Rapids, Michigan
| | - Steven R Bailey
- Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana
| | - Khaldoon Alaswad
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
| | - Michael C Kim
- Department of Cardiology, Lenox Hill Hospital, Northwell Health Medical Centers, New York, New York
| | - Robert D Safian
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan
| | - M Chadi Alraies
- Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan
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12
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Garcia S, Stanberry L, Schmidt C, Sharkey S, Megaly M, Albaghdadi MS, Meraj PM, Garberich R, Jaffer FA, Stefanescu Schmidt AC, Dixon SR, Rade JJ, Smith T, Tannenbaum M, Chambers J, Aguirre F, Huang PP, Kumbhani DJ, Koshy T, Feldman DN, Giri J, Kaul P, Thompson C, Khalili H, Maini B, Nayak KR, Cohen MG, Bangalore S, Shah B, Henry TD. Impact of COVID-19 pandemic on STEMI care: An expanded analysis from the United States. Catheter Cardiovasc Interv 2020; 98:217-222. [PMID: 32767652 PMCID: PMC7436427 DOI: 10.1002/ccd.29154] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care. BACKGROUND We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data. METHODS Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), and average door to balloon (D2B) times. Two periods, January 2019-February 2020 and March-April 2020, were defined to represent periods before (BC) and after (AC) initiation of pandemic mitigation measures, respectively. A generalized estimating equations approach was used to estimate the change in response variables at AC from BC. RESULTS Compared to BC, the AC period was characterized by a marked reduction in the number of activations for STEMI (29%, 95% CI:18-38, p < .001), number of activations leading to angiography (34%, 95% CI: 12-50, p = .005) and number of activations leading to PPCI (20%, 95% CI: 11-27, p < .001). A decline in STEMI activations drove the reductions in angiography and PPCI volumes. Relative to BC, the D2B times in the AC period increased on average by 20%, 95%CI (-0.2 to 44, p = .05). CONCLUSIONS The COVID-19 Pandemic has adversely affected many aspects of STEMI care, including timely access to the cardiac catheterization laboratory for PPCI.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa Stanberry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Christian Schmidt
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Scott Sharkey
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Megaly
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mazen S Albaghdadi
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ross Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Farouc A Jaffer
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Timothy Smith
- The Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
| | | | | | | | | | | | | | - Dmitriy N Feldman
- Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Jay Giri
- Hospital of the University of Pennsylvania and University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Craig Thompson
- NYU Langone Health System and NYU Grossman School of Medicine, New York
| | - Houman Khalili
- Delray Medical Center and Florida Atlantic University, Delray Beach, Florida
| | - Brij Maini
- Delray Medical Center and Florida Atlantic University, Delray Beach, Florida
| | - Keshav R Nayak
- Scripps Mercy Hospital and Cardiac Advisory Committee, County of San Diego Health & Human Services Agency, Emergency Medical Services, San Diego, CA
| | | | - Sripal Bangalore
- NYU Langone Health System and NYU Grossman School of Medicine, New York.,Bellevue Hospital Center and NYU Grossman School of Medicine, New York
| | - Binita Shah
- NYU Langone Health System and NYU Grossman School of Medicine, New York.,Bellevue Hospital Center and NYU Grossman School of Medicine, New York
| | - Timothy D Henry
- The Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
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13
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Gallagher MJ, Bloomingdale R, Berman AD, Williamson BD, Dixon SR, Safian RD. Strategic Deployment of Cardiology Fellows in Training Using the Accreditation Council for Graduate Medical Education Coronavirus Disease 2019 Framework. J Am Heart Assoc 2020; 9:e017443. [PMID: 32476547 PMCID: PMC7660705 DOI: 10.1161/jaha.120.017443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/22/2022]
Abstract
Coronavirus disease 2019 is a global pandemic affecting >3 million people in >170 countries, resulting in >200 000 deaths; 35% to 40% of patients and deaths are in the United States. The coronavirus disease 2019 crisis is placing an enormous burden on health care in the United States, including residency and fellowship training programs. The balance between mitigation, training and education, and patient care is the ultimate determinant of the role of cardiology fellows in training during the coronavirus disease 2019 crisis. On March 24, 2020, the Accreditation Council for Graduate Medical Education issued a formal response to the pandemic crisis and described a framework for operation of graduate medical education programs. Guidance for deployment of cardiology fellows in training during the coronavirus disease 2019 crisis is based on the principles of a medical mission, and adherence to preparation, protection, and support of our fellows in training. The purpose of this review is to describe our departmental strategic deployment of cardiology fellows in training using the Accreditation Council for Graduate Medical Education framework for pandemic preparedness.
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Affiliation(s)
- Michael J Gallagher
- Department of Cardiovascular Medicine Beaumont Hospital-Royal Oak Royal Oak MI
| | | | - Aaron D Berman
- Department of Cardiovascular Medicine Beaumont Hospital-Royal Oak Royal Oak MI
| | - Brian D Williamson
- Department of Cardiovascular Medicine Beaumont Hospital-Royal Oak Royal Oak MI
| | - Simon R Dixon
- Department of Cardiovascular Medicine Beaumont Hospital-Royal Oak Royal Oak MI
| | - Robert D Safian
- Department of Cardiovascular Medicine Beaumont Hospital-Royal Oak Royal Oak MI
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14
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Hanson ID, Tagami T, Mando R, Kara Balla A, Dixon SR, Timmis S, Almany S, Naidu SS, Baran D, Lemor A, Gorgis S, O'Neill W, Basir MB. SCAI
shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv 2020; 96:1137-1142. [DOI: 10.1002/ccd.29139] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Ivan D. Hanson
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Travis Tagami
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Ramy Mando
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Abdalla Kara Balla
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Simon R. Dixon
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Steven Timmis
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Steven Almany
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak Michigan USA
| | - Srihari S. Naidu
- Westchester Medical Center and New York Medical College Valhalla New York USA
| | - David Baran
- Division of Cardiology Sentara Heart Hospital Norfolk Virginia USA
| | - Alejandro Lemor
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - Sarah Gorgis
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - William O'Neill
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
| | - Mir B. Basir
- Division of Cardiology Henry Ford Hospital Detroit Michigan USA
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15
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Chen S, David SW, Khan ZA, Metzger DC, Wasserman HS, Lotfi AS, Hanson ID, Dixon SR, LaLonde TA, Généreux P, Ozan MO, Maehara A, Stone GW. One-year outcomes of supersaturated oxygen therapy in acute anterior myocardial infarction: The IC-HOT study. Catheter Cardiovasc Interv 2020; 97:1120-1126. [PMID: 32649037 PMCID: PMC8246818 DOI: 10.1002/ccd.29090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Supersaturated oxygen (SSO2 ) has recently been approved by the U.S. Food and Drug Administration for administration after primary percutaneous coronary intervention (pPCI) in patients with anterior ST-segment elevation myocardial infarction (STEMI) based on its demonstration of infarct size reduction in the IC-HOT study. OBJECTIVES To describe the 1-year clinical outcomes of intracoronary SSO2 treatment after pPCI in patients with anterior STEMI. METHODS IC-HOT was a prospective, open-label, single-arm study in which 100 patients without cardiogenic shock undergoing successful pPCI of an occluded left anterior descending coronary artery were treated with a 60-min SSO2 infusion. One-year clinical outcomes were compared with a propensity-matched control group of similar patients with anterior STEMI enrolled in the INFUSE-AMI trial. RESULTS Baseline and postprocedural characteristics were similar in the two groups except for pre-PCI thrombolysis in myocardial infarction 3 flow, which was less prevalent in patients treated with SSO2 (9.6% vs. 22.9%, p = .02). Treatment with SSO2 was associated with a lower 1-year rate of the composite endpoint of all-cause death or new-onset heart failure (HF) or hospitalization for HF (0.0% vs. 12.3%, p = .001). All-cause mortality, driven by cardiovascular mortality, and new-onset HF or HF hospitalization were each individually lower in SSO2 -treated patients. There were no significant differences between groups in the 1-year rates of reinfarction or clinically driven target vessel revascularization. CONCLUSIONS Infusion of SSO2 following pPCI in patients with anterior STEMI was associated with improved 1-year clinical outcomes including lower rates of death and new-onset HF or HF hospitalizations.
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Affiliation(s)
- Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York.,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York
| | | | | | | | | | - Amir S Lotfi
- Baystate Medical Center, Springfield, Massachusetts
| | | | | | - Thomas A LaLonde
- Ascension St. John Hospital, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York.,Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey.,Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - M Ozgu Ozan
- Clinical Trials Center, Cardiovascular Research Foundation, New York
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York.,Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York.,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York
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16
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Sukul D, Seth M, Barnes GD, Dupree JM, Syrjamaki JD, Dixon SR, Madder RD, Lee D, Gurm HS. Cardiac Rehabilitation Use After Percutaneous Coronary Intervention. J Am Coll Cardiol 2020; 73:3148-3152. [PMID: 31221264 DOI: 10.1016/j.jacc.2019.03.515] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/21/2019] [Accepted: 03/31/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - James M Dupree
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - John D Syrjamaki
- Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan
| | - Ryan D Madder
- Division of Cardiology, Spectrum Health, Grand Rapids, Michigan
| | - Daniel Lee
- Division of Cardiology, McLaren Health Care, Bay City, Michigan
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of Cardiology, Department of Internal Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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17
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Madder RD, Dixon SR, Seth M, Lee D, Earl T, Hill T, Shah I, Gurm HS. Institutional Variability in Patient Radiation Doses ≥5 Gy During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2020; 13:846-856. [DOI: 10.1016/j.jcin.2019.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
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18
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Allen O, Dixon SR. UNSTABLE ANGINA IN A LOW-RISK PATIENT: “ZERO” DOES NOT MEAN NO-RISK. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Yamamoto MH, Maehara A, Stone GW, Kini AS, Brilakis ES, Rizik DG, Shunk K, Powers ER, Tobis JM, Maini BS, Dixon SR, Goldstein JA, Petersen JL, Généreux P, Shah PR, Crowley A, Nicholls SJ, Mintz GS, Muller JE, Weisz G. 2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques. J Am Coll Cardiol 2020; 75:1371-1382. [DOI: 10.1016/j.jacc.2020.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
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20
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Wanamaker BL, Seth MM, Sukul D, Dixon SR, Bhatt DL, Madder RD, Rumsfeld JS, Gurm HS. Relationship Between Troponin on Presentation and In-Hospital Mortality in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2019; 8:e013551. [PMID: 31547767 PMCID: PMC6806038 DOI: 10.1161/jaha.119.013551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Troponin release in ST-segment-elevation myocardial infarction (STEMI) has predictable kinetics with early levels reflective of ischemia duration. Little research has examined the value of admission troponin levels in STEMI patients undergoing primary percutaneous coronary intervention. We investigated the relationship between troponin on presentation and mortality in a large, real-world cohort of STEMI patients undergoing primary percutaneous coronary intervention. Methods and Results We used multivariable adaptive regression modeling to examine the association between admission troponin levels and in-hospital mortality for patients who underwent primary percutaneous coronary intervention for STEMI. We adjusted for known clinical risk factors using a validated mortality risk model derived from the NCDR (National Cardiovascular Data Registry) CathPCI database, and this same model was used to calculate patients' predicted mortality based on clinical and demographic factors. Patients were then stratified by troponin groups to compare predicted versus observed mortality. Of the 14 061 patients included in the cohort, 47.2% had initial troponin levels that were undetectable or within the reference range. Admission troponin was an independent predictor of in-hospital mortality, and any value above the reference range was associated with increased mortality (1.8% versus 5.1%, [standardized difference, 18.2%]). Patients with the highest predicted risk for mortality (13% predicted) in the highest admission troponin grouping experienced an observed mortality of 19.5%. Patients in low troponin groupings consistently demonstrated lower than predicted mortality based on their clinical and demographic risk profile. Conclusions Nearly half of patients undergoing primary percutaneous coronary intervention had normal troponin on presentation and had a relatively good outcome. Mortality increases with elevated admission troponin levels, regardless of baseline clinical risk. The substantial number of patients who present with markedly elevated troponin and their relatively worse outcomes highlights the need for continued improvement in prehospital STEMI detection and care.
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Affiliation(s)
- Brett L Wanamaker
- Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Ann Arbor MI
| | - Milan M Seth
- Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Ann Arbor MI
| | - Devraj Sukul
- Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Ann Arbor MI
| | - Simon R Dixon
- Department of Cardiovascular Medicine Beaumont Hospital Royal Oak Royal Oak MI
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center Harvard Medical School Boston MA
| | - Ryan D Madder
- Frederik Meijer Heart & Vascular Institute Spectrum Health Grand Rapids MI
| | - John S Rumsfeld
- Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Ann Arbor MI
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21
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Song C, Sukul D, Seth M, Wohns D, Dixon SR, Slocum NK, Gurm HS. Outcomes After Percutaneous Coronary Intervention in Patients With a History of Cerebrovascular Disease: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Circ Cardiovasc Interv 2019; 11:e006400. [PMID: 29895601 DOI: 10.1161/circinterventions.118.006400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/10/2018] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of shared risk factors between coronary artery disease and cerebrovascular disease, patients with a history of transient ischemic attack (TIA) or stroke are at greater risk of developing coronary artery disease, which may require percutaneous coronary intervention (PCI). However, there remains a paucity of research examining outcomes after PCI in these patients. METHODS AND RESULTS We analyzed consecutive patients who underwent PCI between January 1, 2013, and March 31, 2016, at 47 Michigan hospitals and identified those with a history of TIA/stroke. We used propensity score matching to adjust for differences in baseline characteristics and compared in-hospital outcomes between patients with and without a history of TIA/stroke. We compared rates of 90-day readmission and long-term mortality in a subset of patients. Among 98 730 patients who underwent PCI, 10 915 had a history of TIA/stroke. After matching (n=10 618 per group), a history of TIA/stroke was associated with an increased risk of in-hospital stroke (adjusted odds ratio, 2.04; 95% confidence interval, 1.41-2.96; P<0.001). There were no differences in the risks of other in-hospital outcomes. In a subset of patients with postdischarge data, a history of TIA/stroke was associated with increased risks of 90-day readmission (adjusted odds ratio, 1.22; 95% confidence interval, 1.09-1.38; P<0.001) and long-term mortality (hazard ratio, 1.23; 95% confidence interval, 1.07-1.43; P=0.005). CONCLUSIONS A history of TIA/stroke was common in patients who underwent PCI and was associated with increased risks of in-hospital stroke, 90-day readmission, and long-term mortality. Given the devastating consequences of post-PCI stroke, patients with a history of TIA/stroke should be counseled on this increased risk before undergoing PCI.
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Affiliation(s)
- Chris Song
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (C.S.)
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (D.S., M.S., H.S.G.)
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (D.S., M.S., H.S.G.)
| | - David Wohns
- Division of Cardiology, Spectrum Health, Grand Rapids, MI (D.W.)
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI (S.R.D.)
| | - Nicklaus K Slocum
- Grand Traverse Heart Associates, Department of Cardiology, Traverse Heart and Vascular, Traverse City, MI (N.K.S.)
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor (D.S., M.S., H.S.G.).,Division of Cardiology, Department of Internal Medicine, VA Ann Arbor Healthcare System, MI (H.S.G.)
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22
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Chinnaiyan KM, Safian RD, Gallagher ML, George J, Dixon SR, Bilolikar AN, Abbas AE, Shoukfeh M, Brodsky M, Stewart J, Cami E, Forst D, Timmis S, Crile J, Raff GL. Clinical Use of CT-Derived Fractional Flow Reserve in the Emergency Department. JACC Cardiovasc Imaging 2019; 13:452-461. [PMID: 31326487 DOI: 10.1016/j.jcmg.2019.05.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to examine the feasibility, safety, clinical outcomes, and costs associated with computed tomography-derived fractional flow reserve (FFRCT) in acute chest pain (ACP) patients in a coronary computed tomography angiography (CTA)-based triage program. BACKGROUND FFRCT is useful in determining lesion-specific ischemia in patients with stable ischemic heart disease, but its utility in ACP has not been studied. METHODS ACP patients with no known coronary artery disease undergoing coronary CTA and coronary CTA with FFRCT were studied. FFRCT ≤0.80 was considered positive for hemodynamically significant stenosis. RESULTS Among 555 patients, 297 underwent coronary CTA and FFRCT (196 negative, 101 positive), whereas 258 had coronary CTA only. The rejection rate for FFRCT was 1.6%. At 90 days, there was no difference in major adverse cardiac events (including death, nonfatal myocardial infarction, and unexpected revascularization after the index visit) between the coronary CTA and FFRCT groups (4.3% vs. 2.7%; p = 0.310). Diagnostic failure, defined as discordance between the coronary CTA or FFRCT results with invasive findings, did not differ between the groups (1.9% vs. 1.68%; p = NS). No deaths or myocardial infarction occurred with negative FFRCT when revascularization was deferred. Negative FFRCT was associated with higher nonobstructive disease on invasive coronary angiography (56.5%) than positive FFRCT (8.0%) and coronary CTA (22.9%) (p < 0.001). There was no difference in overall costs between the coronary CTA and FFRCT groups ($8,582 vs. $8,048; p = 0.550). CONCLUSIONS In ACP, FFRCT is feasible, with no difference in major adverse cardiac events and costs compared with coronary CTA alone. Deferral of revascularization is safe with negative FFRCT, which is associated with higher nonobstructive disease on invasive angiography.
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Affiliation(s)
| | - Robert D Safian
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | | | - Julie George
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Abhay N Bilolikar
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Mazen Shoukfeh
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Marc Brodsky
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - James Stewart
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Elvis Cami
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - David Forst
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Steven Timmis
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Jason Crile
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
| | - Gilbert L Raff
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan
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23
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Nakahama H, Jankowski M, Dixon SR, Abbas AE. Long-term outcome of brachytherapy treatment for coronary in-stent restenosis: Ten-year follow-up. Catheter Cardiovasc Interv 2019; 93:E211-E216. [PMID: 30280480 DOI: 10.1002/ccd.27866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/18/2018] [Revised: 07/02/2018] [Accepted: 08/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study was to determine the long-term major adverse cardiac events (MACE) in patients treated with intracoronary brachytherapy (ICBT) for coronary in-stent restenosis (ISR). BACKGROUND ICBT was commonly used to treat coronary ISR prior to the availability of drug-eluting stents (DES). The long-term outcomes of ICBT for ISR remain unknown. METHODS Six hundred and eighty consecutive patients who underwent ICBT treated for ISR between September 1998 and April 2005 were included in the study. Clinical and angiographic data were collected and the long-term MACE were measured for all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR) at 10-year follow-up. RESULTS Patients were 63 ± 11 years old (66% male). The majority of patients were treated with a bare metal stent 670/680 (99%) prior to ICBT. Significant baseline clinical findings include high incidence of smokers 479/680 (70%), hyperlipidemia 638/680 (94%), and multivessel disease 526/680 (77%). The majority of target lesions were diffuse 407/680 (60%), and either in the left anterior descending 258/680 (38%) or right coronary artery 215/680 (32%). At 10-year follow-up, the rate of death was 25%, MI was 22.4%, and TVR was 48%. CONCLUSION MACE at 10-year follow-up following ICBT for ISR indicates steady rate of death and MI and declining rate of TVR after 5 years.
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Affiliation(s)
- Hiroko Nakahama
- Beaumont Hospital Royal Oak, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Michelle Jankowski
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Simon R Dixon
- Beaumont Hospital Royal Oak, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Amr E Abbas
- Beaumont Hospital Royal Oak, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
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24
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Feldmann KJ, Goldstein JA, Marinescu V, Dixon SR, Raff GL. Disparate Impact of Ischemic Injury on Regional Wall Dysfunction in Acute Anterior vs Inferior Myocardial Infarction. Cardiovasc Revasc Med 2018; 20:965-972. [PMID: 30611651 DOI: 10.1016/j.carrev.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute transmural ischemia should induce similar magnitude of wall motion abnormality (WMA) in both anterior myocardial infarction (AMI) and inferior (IMI). However, patients with AMI generally suffer more severe hemodynamic compromise. METHODS This retrospective study compared WMA's in ST segment elevation MI patients undergoing primary reperfusion and subsequent cardiac MRI. Regional systolic wall motion and thickening were assessed in all segments throughout the left ventricle (LV). RESULTS We analyzed 37 patients (AMI = 24 vs IMI = 13). Reperfusion success was achieved in all and there were no differences between groups in door-to-balloon time (AMI median 77 vs IMI 119 min, p = 0.085). Compared to IMI, in AMI LV ejection fraction was more depressed (37 ± 7.6% vs 51 ± 10.3%, P = 0.0006) and regional WMA more severe (total regional WMA score = 2.63 ± 0.53 vs IMI = 2.1 ± 0.52, P = 0.007). Regional dyskinesis was commonly observed in AMI patients but was rare in IMI (79% vs 7% of cases). Similarly, AMI manifested systolic thinning, whereas thickening was depressed but still present in IMI patients. Strikingly, WMA severity differed downstream relative to the origin of the infarct artery: In all AMI cases, WMA worsened from proximal anterior toward the distal apical zone; in IMI the pattern was reverse, with WMA consistently most severe in the basal segment of the inferior-posterior wall with preservation toward the apical distribution of the infarct vessel. CONCLUSION These results demonstrate a disparate impact of ischemic injury on mechanical performance of the anterior vs inferior-posterior walls. These findings may be attributable to differences between the walls in architecture, mechanics and coronary blood flow. These observations may have implications for myocardial salvage, remodeling and prognosis.
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Affiliation(s)
- Kyle J Feldmann
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - James A Goldstein
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA.
| | - Victor Marinescu
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
| | - Gilbert L Raff
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI, USA
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25
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David SW, Khan ZA, Patel NC, Metzger DC, Wood FO, Wasserman HS, Lotfi AS, Hanson ID, Dixon SR, LaLonde TA, Généreux P, Ozan MO, Maehara A, Stone GW. Evaluation of intracoronary hyperoxemic oxygen therapy in acute anterior myocardial infarction: The IC‐HOT study. Catheter Cardiovasc Interv 2018; 93:882-890. [DOI: 10.1002/ccd.27905] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 01/30/2023]
Affiliation(s)
| | - Zubair A. Khan
- Providence‐Providence Park Hospital Southfield Michigan
- North Alabama Medical Center Florence Alabama
| | | | | | | | | | | | | | | | | | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center Morristown New Jersey
- Hôpital du Sacré‐Coeur de Montréal Montréal Québec Canada
- Cardiovascular Research Foundation New York New York
| | | | - Akiko Maehara
- Cardiovascular Research Foundation New York New York
- Columbia University Medical Center New York New York
| | - Gregg W. Stone
- Cardiovascular Research Foundation New York New York
- Columbia University Medical Center New York New York
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Gurm HS, Seth M, Dixon SR, Michael Grossman P, Sukul D, Lalonde T, Cannon L, West D, Madder RD, Adam Lauver D. Contemporary use of and outcomes associated with ultra‐low contrast volume in patients undergoing percutaneous coronary interventions. Catheter Cardiovasc Interv 2018; 93:222-230. [DOI: 10.1002/ccd.27819] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/15/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Hitinder S. Gurm
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Ann Arbor Michigan
| | - Milan Seth
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Ann Arbor Michigan
| | | | - P. Michael Grossman
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Ann Arbor Michigan
| | - Devraj Sukul
- Department of Internal Medicine, Division of Cardiovascular MedicineUniversity of Michigan Ann Arbor Michigan
| | | | | | | | - Ryan D. Madder
- Frederick Meijer Heart and Vascular Institute, Spectrum Health Grand Rapids Michigan
| | - D. Adam Lauver
- Department of Pharmacology and ToxicologyMichigan State University East Lansing Michigan
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Song C, Sukul D, Seth M, Dupree JM, Khandelwal A, Dixon SR, Wohns D, LaLonde T, Gurm HS. Ninety-Day Readmission and Long-Term Mortality in Medicare Patients (≥65 Years) Treated With Ticagrelor Versus Prasugrel After Percutaneous Coronary Intervention (from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium). Am J Cardiol 2017; 120:1926-1932. [PMID: 29025684 DOI: 10.1016/j.amjcard.2017.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022]
Abstract
Ticagrelor and prasugrel were found to be superior to clopidogrel for the treatment of acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI); however, the comparative effectiveness of these 2 drugs remains unknown. We compared postdischarge outcomes among older patients treated with ticagrelor versus prasugrel after PCI for ACS. We linked clinical data from PCIs performed in older patients (age ≥65) for ACS at 47 Michigan hospitals to Medicare fee-for-service claims from January 1, 2013, to December 31, 2014, to ascertain rates of 90-day readmission and long-term mortality. We used propensity score matching to adjust for the nonrandom use of ticagrelor and prasugrel at discharge. Logistic regression and Cox proportional hazards models were used to compare rates of 90-day readmission and long-term mortality, respectively. Patients discharged on ticagrelor (n = 1,243) were more frequently older, female, had a history of cerebrovascular disease, and presented with ST- or non-ST-elevation myocardial infarction compared with prasugrel (n = 1,014). After matching (n = 756 per group), there were no significant differences in the rates of 90-day readmission (16.7% ticagrelor vs 14.6% prasugrel; adjusted odds ratio 1.15, 95% confidence interval 0.86 to 1.55, p = 0.35) or 1-year mortality (5.4% ticagrelor vs 3.7% prasugrel; hazard ratio 1.3, 95% confidence interval 0.8 to 2.2, p = 0.31). In conclusion, we found no significant differences in the rates of 90-day readmission or long-term mortality between older patients treated with ticagrelor and patients treated with prasugrel after PCI for ACS. In the absence of randomized data to the contrary, these 2 treatments appear similarly effective.
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Goldstein JA, Dixon SR, Douglas PS, Ohman EM, Moses J, Popma JJ, O'Neill WW. Maintenance of valvular integrity with Impella left heart support: Results from the multicenter PROTECT II randomized study. Catheter Cardiovasc Interv 2017; 92:813-817. [PMID: 28988424 DOI: 10.1002/ccd.27242] [Citation(s) in RCA: 5] [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: 04/17/2017] [Accepted: 07/22/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Impella 2.5 axial flow pump, which is positioned across the aortic valve, is widely employed for hemodynamic support. The present study compared structural and functional integrity of the left heart valves in patients undergoing Impella vs intra-aortic balloon pump in the randomized PROTECT II trial. METHODS AND RESULTS Transthoracic echocardiograms were performed at baseline, 1 and 3 months in 445 patients in the PROTECT II trial. Serial studies were analyzed by an independent echocardiography core laboratory for aortic and mitral valve structure and function, and left ventricular ejection fraction (LVEF). During Impella support there was no appreciable change in the degree of baseline valvular regurgitation. There were no cases of structural derangement of the mitral or aortic valve after use of the Impella device. At 90-day follow-up, there was an average 22% relative increase in LVEF from baseline (27% ± 9 vs. 33% ± 11, P < 0.001). CONCLUSIONS The present echocardiographic analysis of the PROTECT II study confirms prior observations regarding the safety of the Impella 2.5 device with respect to mitral and aortic valve function.
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Affiliation(s)
| | | | | | | | - Jeffrey Moses
- Columbia University Medical Center New York Presbyterian Hospital, New York
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Sukul D, Seth M, Dixon SR, Khandelwal A, LaLonde TA, Gurm HS. Contemporary Trends and Outcomes Associated With the Preprocedural Use of Oral P2Y12 Inhibitors in Patients Undergoing Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). J Invasive Cardiol 2017; 29:340-351. [PMID: 28420804 PMCID: PMC5699908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We sought to describe trends in the use of preprocedural P2Y12 inhibitors and their clinical impact in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND Oral P2Y12 inhibitors are ubiquitously used medications; however, the specific timing of initial P2Y12 inhibitor administration remains intensely debated. METHODS Our study population comprised 74,053 consecutive patients undergoing PCI at 47 hospitals in Michigan from January 2013 through June 2015. In-hospital outcomes included stent thrombosis, bleeding, need for transfusion, and death. Hierarchical logistic regression, propensity matching, and targeted maximum likelihood estimation were used to adjust for baseline patient differences and clustering, and to minimize bias. RESULTS Of 24,733 patients who received a preprocedural P2Y12 inhibitor, 82% received clopidogrel, 8% prasugrel, and 10% ticagrelor. Preprocedural administration of P2Y12 inhibitors declined during the study (49.3% to 24.8%; P<.001), and varied greatly across hospitals (14.5%-95.9%). No significant differences in outcomes were observed between patients receiving preprocedural clopidogrel and a matched cohort of those not receiving any preprocedural P2Y12 inhibitor (stent thrombosis: adjusted odds ratio [OR], 1.55; 95% confidence interval [CI], 0.30-7.84; bleeding: OR, 0.96; 95% CI, 0.63-1.46; transfusion: OR, 1.03; 95% CI, 0.69-1.55; and death: OR, 0.95; 95% CI, 0.38-2.37). Similar findings were demonstrated for preprocedural ticagrelor and prasugrel. Results from a subgroup analysis of patients with non-ST segment elevation acute coronary syndrome (n = 28,072) were consistent with the overall findings. CONCLUSIONS There was a substantial decline in the rate of preprocedural P2Y12 inhibitor administration during the study. Furthermore, there were no significant differences in outcomes between patients treated with preprocedural P2Y12 inhibitors and those who were not.
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Affiliation(s)
| | | | | | | | | | - Hitinder S Gurm
- University of Michigan Cardiovascular Center, 2A 394, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5853 USA.
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Sukul D, Seth M, Dixon SR, Zainea M, Slocum NK, Pielsticker EJ, Gurm HS. Clinical outcomes of percutaneous coronary intervention in patients turned down for surgical revascularization. Catheter Cardiovasc Interv 2016; 90:94-101. [DOI: 10.1002/ccd.26781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Devraj Sukul
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
| | - Simon R. Dixon
- Division of Cardiology, Department of Medicine; Beaumont Hospital; Royal Oak Michigan
| | | | | | | | - Hitinder S. Gurm
- Division of Cardiovascular Medicine, Department of Medicine; University of Michigan; Ann Arbor Michigan
- Veterans Affairs Medical Center; Ann Arbor Michigan
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Gurm HS, Sanz-Guerrero J, Johnson DD, Jensen A, Seth M, Chetcuti SJ, Lalonde T, Greenbaum A, Dixon SR, Shih A. Using simulation for teaching femoral arterial access: A multicentric collaboration. Catheter Cardiovasc Interv 2015; 87:376-80. [PMID: 26489781 DOI: 10.1002/ccd.26256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the impact of simulation training on complications associated with femoral arterial access obtained by first year cardiology fellows. BACKGROUND Prior studies demonstrate a higher incidence of arterial access related complications among patients undergoing invasive cardiac procedures. METHODS First year cardiology fellows at four teaching hospitals in Michigan tracked their femoral access experience and any associated complications between July 2011 and June 2013. Fellows starting their academic training in July 2012 were first trained on a specially developed simulator before starting their rotation in the catheterization laboratory. The primary outcome was access proficiency, defined as five successful femoral access attempts without any complication or need to seek help from a more experienced team member. RESULTS A total of 1,278 femoral access attempts were made by 21 fellows in 2011-2012 compared with 869 femoral access attempts made by 21 fellows in 2012-2013. There was a lower rate of access related complications in patients undergoing access attempts by first year fellows in year 2 compared with year 1 (2.1% versus 4.5%, P = 0.003). The number of procedures to achieve procedural proficiency was significantly higher in year 1 compared with year 2 (median 20 versus 10, P = 0.007). CONCLUSIONS Incorporation of simulation in the training of first year fellows was associated with an improvement in proficiency and a clinically meaningful reduction in vascular complications.
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Affiliation(s)
- Hitinder S Gurm
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jorge Sanz-Guerrero
- Facultades De Ingenieria Medicina Y Ciencias Biologicas, Instituto De Ingenieria Biologica Y Medica, Pontificia Universidad Catolica De Chile, Santiago, Chile.,Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan
| | - Daniel D Johnson
- Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan
| | - Andrea Jensen
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Milan Seth
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Thomas Lalonde
- Department of Cardiovascular Medicine, St. John Hospital, Detroit, Michigan
| | - Adam Greenbaum
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan
| | - Albert Shih
- Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan.,Biomedical Engineering, University of Michigan, Ann Arbor
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McDonagh JR, Seth M, LaLonde TA, Khandewal AK, Wohns DH, Dixon SR, Gurm HS. Radial PCI and the obesity paradox: Insights from blue cross blue shield of michigan cardiovascular consortium (BMC2). Catheter Cardiovasc Interv 2015; 87:211-9. [DOI: 10.1002/ccd.26015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/18/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Jonathan R. McDonagh
- Division of Cardiovascular Medicine; University of Michigan Medical Center; Ann Arbor Michigan
| | - Milan Seth
- Blue Cross Blue Shield of Michigan Cardiovascular Consortium; University of Michigan Medical Center; Ann Arbor Michigan
| | - Thomas A. LaLonde
- Division of Cardiology; St. John Providence Health System, Wayne State University; Detroit Michigan
| | | | | | - Simon R. Dixon
- Department of Cardiovascular Medicine; Beaumont Hospital; Royal Oak Michigan
| | - Hitinder S. Gurm
- Division of Cardiovascular Medicine; University of Michigan Medical Center; Ann Arbor Michigan
- Blue Cross Blue Shield of Michigan Cardiovascular Consortium; University of Michigan Medical Center; Ann Arbor Michigan
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Hanson ID, David SW, Dixon SR, Metzger DC, Généreux P, Maehara A, Xu K, Stone GW. “Optimized” delivery of intracoronary supersaturated oxygen in acute anterior myocardial infarction: A feasibility and safety study. Catheter Cardiovasc Interv 2015; 86 Suppl 1:S51-7. [DOI: 10.1002/ccd.25773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/21/2014] [Accepted: 11/29/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Philippe Généreux
- Hôpital Du Sacré-Coeur De Montréal; Montréal Québec Canada
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Akiko Maehara
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Ke Xu
- Cardiovascular Research Foundation; New York New York
| | - Gregg W. Stone
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
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Goldstein JA, Dixon SR. In-stent neoatherosclerosis and distal embolization: lesion architecture, composition, and PCI compression. Catheter Cardiovasc Interv 2015; 85:573-4. [PMID: 25702907 DOI: 10.1002/ccd.25853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 11/09/2022]
Affiliation(s)
- James A Goldstein
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, Michigan
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Pershad A, Fraij G, Massaro JM, David SW, Kleiman NS, Denktas AE, Wilson BH, Dixon SR, Ohman EM, Douglas PS, Moses JW, O'Neill WW. Comparison of the use of hemodynamic support in patients ≥80 years versus patients <80 years during high-risk percutaneous coronary interventions (from the Multicenter PROTECT II Randomized Study). Am J Cardiol 2014; 114:657-64. [PMID: 25037676 DOI: 10.1016/j.amjcard.2014.05.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
The outcomes of hemodynamic support during high-risk percutaneous coronary intervention in the very elderly are unknown. We sought to compare outcomes between the patients ≥80 years versus patients <80 years enrolled in the PROTECT II (Prospective Randomized Clinical Trial of Hemodynamic Support with the Impella 2.5 versus Intra-Aortic Balloon Pump in Patients undergoing High Risk Percutaneous Coronary Intervention) randomized trial. Patients who underwent high-risk percutaneous coronary intervention with an unprotected left main or last patent conduit and a left ventricular ejection fraction ≤35% or with 3-vessel disease and a left ventricular ejection fraction ≤30% were randomized to receive an intra-aortic balloon pump or the Impella 2.5; 90-day (or the longest follow-up) outcomes were compared between patients ≥80 years (n = 59) and patients <80 years (n = 368). At 90 days, the composite end point of major adverse events and major adverse cerebral and cardiac events were similar between patients ≥80 and <80 years (45.6% vs 44.1%, p = 0.823, and 23.7% vs 26.8%, p = 0.622, respectively). There were no differences in death, stroke, or myocardial infarction rates between the 2 groups, but fewer repeat revascularization procedures were required in patients ≥80 years (1.7% vs 10.4%, p = 0.032). Bleeding and vascular complication rates were low and comparable between the 2 age groups (3.4% vs 2.4%, p = 0.671, and 6.8% vs 5.4%, p = 0.677, respectively). Multivariate analysis confirmed that age was not an independent predictor of major adverse events (odds ratio = 1.031, 95% confidence interval 0.459-2.315, p = 0.941), whereas Impella 2.5 was an independent predictor for improved outcomes irrespective of age (odds ratio = 0.601, 95% confidence interval 0.391-0.923, p = 0.020). In conclusion, the use of percutaneous circulatory support is reasonable and feasible in a selected octogenarian population with similar outcomes as those of younger selected patients. Irrespective of age, the use of Impella 2.5 was an independent predictor of favorable outcomes.
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Dangas GD, Kini AS, Sharma SK, Henriques JP, Claessen BE, Dixon SR, Massaro JM, Palacios I, Popma JJ, Ohman EM, Stone GW, O'Neill WW. Impact of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump on prognostically important clinical outcomes in patients undergoing high-risk percutaneous coronary intervention (from the PROTECT II randomized trial). Am J Cardiol 2014; 113:222-8. [PMID: 24527505 DOI: 10.1016/j.amjcard.2013.09.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A periprocedural myocardial infarction, defined as the advent of new Q-waves or a creatine kinase-MB elevation >83 normal has been previously validated as predictive of subsequent mortality. We examined the effects of using this clinically relevant definition of periprocedural myocardial infarction instead of the original protocol definition on outcomes in the recent PROTECT II [A Prospective, Multi-center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump (IABP) in Patients Undergoing Non Emergent High Risk PCI] trial. In this trial, patients who were undergoing high-risk percutaneous coronary intervention (PCI) were randomized to either an intraaortic balloon pump (IABP, n[211) or a left ventricular assist device (Impella, n[216). All eligible patients per study protocol were included in the analysis. Patient outcomes were compared up to 90 days, the longest available follow-up, on the composite end points of major adverse events (MAE) and major adverse cardiac and cerebral events (MACCE [ death, stroke, myocardial infarction, and repeat revascularization). At 90 days, the rates of both composite end points were lower in the Impella group compared with the IABP group (MAE, 37% vs 49%, p [ 0.014 respectively; MACCE, 22% vs 31%, p [ 0.034 respectively). There were no differences in death or large myocardial infarction between the 2 arms. By multivariable analysis, treatment with Impella as opposed to IABP was an independent predictor for freedom from MAE (odds ratio[0.75 [95% confidence interval 0.61 to 0.92], p[0.007) andMACCE (odds ratio[0.76 [95% confidence interval 0.61 to 0.96], p[0.020) at 90 days postprocedure. In conclusion, hemodynamic support with Impella compared with IABP during high-risk PCI in the PROTECT-II trial resulted in improved event-free survival at 3-month follow-up; this finding was further supported by multivariate analyses.
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O'Neill WW, Schreiber T, Wohns DHW, Rihal C, Naidu SS, Civitello AB, Dixon SR, Massaro JM, Maini B, Ohman EM. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol 2013; 27:1-11. [PMID: 24329756 PMCID: PMC4238821 DOI: 10.1111/joic.12080] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [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] [Indexed: 12/14/2022] Open
Abstract
Objectives To evaluate the periprocedural characteristics and outcomes of patients supported with Impella 2.5 prior to percutaneous coronary intervention (pre-PCI) versus those who received it after PCI (post-PCI) in the setting of cardiogenic shock (CS) complicating an acute myocardial infarction (AMI). Background Early mechanical circulatory support may improve outcome in the setting of CS complicating an AMI. However, the optimal timing to initiate hemodynamic support has not been well characterized. Methods Data from 154 consecutive patients who underwent PCI and Impella 2.5 support from 38 US hospitals participating in the USpella Registry were included in our study. The primary end-point was survival to discharge. Secondary end-points included assessment of patients’ hemodynamics and in-hospital complications. A multivariate regression model was used to identify independent predictors for mortality. Results Both groups were comparable except for diabetes (P = 0.02), peripheral vascular disease (P = 0.008), chronic obstructive pulmonary disease (P = 0.05), and prior stroke (P = 0.04), all of which were more prevalent in the pre-PCI group. Patients in the pre-PCI group had more lesions (P = 0.006) and vessels (P = 0.01) treated. These patients had also significantly better survival to discharge compared to patients in the post-PCI group (65.1% vs.40.7%, P = 0.003). Survival remained favorable for the pre-PCI group after adjusting for potential confounding variables. Initiation of support prior to PCI with Impella 2.5 was an independent predictor of in-hospital survival (Odds ratio 0.37, 95% confidence interval: 0.17–0.79, P = 0.01) in multivariate analysis. The incidence of in-hospital complications included in the secondary end-point was similar between the 2 groups. Conclusions The results of our study suggest that early initiation of hemodynamic support prior to PCI with Impella 2.5 is associated with more complete revascularization and improved survival in the setting of refractory CS complicating an AMI.
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Mehta RH, Harjai KJ, Boura JA, Tcheng JE, Dixon SR, Stone GW, Grines CL. Short-term outcomes of balloon angioplasty versus stent placement for patients undergoing primary percutaneous coronary intervention: Implications for patients requiring early coronary artery bypass surgery. Am Heart J 2013; 165:1000-7. [PMID: 23708173 DOI: 10.1016/j.ahj.2013.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/14/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with acute ST-elevation myocardial infarction (STEMI) needing early coronary artery bypass graft (CABG) surgery, it is unknown whether primary percutaneous balloon angioplasty (PTCA)-without stent implantation-allows safe transition to subsequent CABG. METHODS We examined acute STEMI patients enrolled in the Stent-PAMI and CADILLAC trials to study the differences in the early clinical events between those treated with primary PTCA (n = 1494) or primary stenting (n = 1488). RESULTS Baseline clinical and pre- and post-procedural angiographic features including post-intervention TIMI 3 flow rates were similar in the 2 groups with the exception of higher median infarct-artery residual stenosis in the PTCA group (26% [IQR 19%-34%] vs. 18% [IQR 11-25%], P < .001]. Provisional stenting was required in 16% of patients in PTCA group, while stents could not be implanted in 2% of the stent group. Sixty-percent of PTCA patients had stent-like balloon result. The rate of 30-day ischemia-driven target vessel revascularization was higher in the PTCA group (4.3% vs. 2.0%, P < .001 [4.6% vs 2.3%, P < .001 among patients with multivessel disease and 3.4% vs. 2.0%, P = .044 in patients with stent-like balloon results]) while 30-day major adverse cardiac events (6.2% vs 4.9%), death (1.8% versus 2.8%), and reinfarction (0.9% vs. 0.7%) were similar in the 2 groups. CONCLUSIONS Compared with primary stenting, primary PTCA of infarct artery in STEMI patients was associated with significant increase in ischemia-driven target vessel revascularization (ITVR) rate, yet with no increased risk of major adverse cardiac events, reinfarction or death. Thus, provided close surveillance is maintained and prompt treatment initiated for early ischemic events, PTCA (particularly in those with stent-like balloon result) may be a reasonable and safe option in STEMI patients needing early CABG.
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Dorval JF, Dixon SR, Zelman RB, Davidson CJ, Rudko R, Resnic FS. Feasibility study of the RenalGuard™ balanced hydration system: A novel strategy for the prevention of contrast-induced nephropathy in high risk patients. Int J Cardiol 2013; 166:482-6. [DOI: 10.1016/j.ijcard.2011.11.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 10/22/2011] [Accepted: 11/24/2011] [Indexed: 12/22/2022]
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Wood FO, Leonowicz NA, Vanhecke TE, Dixon SR, Grines CL. Mortality in patients with ST-segment elevation myocardial infarction who do not undergo reperfusion. Am J Cardiol 2012; 110:509-14. [PMID: 22633204 DOI: 10.1016/j.amjcard.2012.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 11/26/2022]
Abstract
Reperfusion therapy reduces mortality in patients presenting with ST-segment elevation myocardial infarctions (STEMI). However, some patients may not receive thrombolytic therapy or undergo primary percutaneous coronary intervention. The decision making and clinical outcomes of these patients have not been well described. In this study, 139 patients were identified from a total of 1,126 patients with STEMI who did not undergo reperfusion therapy at a high-volume percutaneous coronary intervention center from October 2006 to March 2011. Clinical data, reasons for no reperfusion, management, and mortality were obtained by chart review. The mean age was 80 ± 13 years (61% women, 31% diabetic, and 37% known coronary artery disease). Of the 139 patients, 72 (52%) presented with primary diagnoses other than STEMI, and 39 (28%) developed STEMI >24 hours after admission. The most common reasons for no reperfusion were advanced age, co-morbid conditions, acute or chronic kidney injury, delayed presentation, advance directives precluding reperfusion, patient preference, and dementia. Eighty-four patients (60%) had ≥ 3 reasons for no reperfusion. Factors associated with hospital mortality were cardiogenic shock, intubation, and advance directives prohibiting reperfusion after physician consultation. In hospital and 1-year mortality were 53% and 69%, respectively. In conclusion, at a high-volume percutaneous coronary intervention center, most patients presenting with STEMI underwent immediate catheterization. The decision for no reperfusion was multifactorial, with advanced age reported as the most common factor. Outcomes were poor in this population, and fewer than half of these patients survived to hospital discharge.
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Slocum NK, Grossman PM, Moscucci M, Smith DE, Aronow HD, Dixon SR, Share D, Gurm HS. The changing definition of contrast-induced nephropathy and its clinical implications: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Am Heart J 2012; 163:829-34. [PMID: 22607861 DOI: 10.1016/j.ahj.2012.02.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 02/09/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The traditional definition of contrast-induced nephropathy (CIN) has been an absolute rise of serum creatinine (Cr) of ≥0.5 mg/dL, although most recent clinical trials have included a ≥25% increase from baseline Cr. The clinical implication of this definition change remains unknown. METHODS AND RESULTS We compared the association of the two definitions with risk of death or need for dialysis among 58,957 patients undergoing percutaneous coronary intervention in 2007 to 2008 in a large collaborative registry. Patients with a preexisting history of renal failure requiring dialysis were excluded. Contrast-induced nephropathy as defined by a rise in Cr ≥0.5 mg/dL (CIN(Traditional)) developed in 1,601, whereas CIN defined either as Cr ≥0.5 mg/dL or ≥25% increase in baseline Cr (CIN(New)) developed in 4,308 patients. Patients meeting the definition of CIN(New) but not CIN(Traditional) were classified as CIN(Incremental) (n = 2,707). Compared with CIN(New), CIN(Traditional) was more commonly seen in patients with abnormal renal function, which was more likely to develop in patients with normal renal function at baseline. Compared with CIN(Incremental), patients meeting the definition of CIN(Traditional) were more likely to die (16.7% vs 1.7%) and require in-hospital dialysis (9.8% vs 0%). CONCLUSIONS Our data suggest that the traditional definition of CIN (a rise in Cr of ≥0.5 mg/dL) in patients undergoing PCI is superior to ≥25% increase in Cr at identifying patients at greater risk for adverse renal and cardiac events.
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Affiliation(s)
- Nicklaus K Slocum
- University of Michigan School of Medicine, Cardiovascular Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5853, USA
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Madder RD, Smith JL, Dixon SR, Goldstein JA. Composition of Target Lesions by Near-Infrared Spectroscopy in Patients With Acute Coronary Syndrome Versus Stable Angina. Circ Cardiovasc Interv 2012; 5:55-61. [DOI: 10.1161/circinterventions.111.963934] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Whereas acute coronary syndromes (ACS) typically develop from the rupture of lipid core plaque (LCP), lesions causing stable angina are believed to be composed of fibrocalcific plaque. In this study, intracoronary near-infrared spectroscopy (NIRS) was used to determine the frequency of LCP at target and remote sites in patients with ACS versus those with stable angina.
Methods and Results—
The study was performed in patients having ≥1 target lesion identified by invasive angiography who also underwent NIRS before intervention. LCP was defined as a 2-mm segment on the NIRS block chemogram having a strong positive reading indicated by a bright-yellow color. Patients with ACS and those with stable angina were compared for the frequency of LCP at target and remote sites. Among 60 patients (46.7% with ACS) undergoing invasive angiography and NIRS, 68 target lesions were identified. Although target lesions in patients with ACS were more frequently composed of LCP than targets in patients with stable angina (84.4% versus 52.8%,
P
=0.004), approximately one half of target lesions in patients with stable angina contained LCP. LCPs anatomically remote from the target lesion were frequent in patients with ACS and less common in patients with stable angina (73.3% versus 17.6%,
P
=0.002).
Conclusions—
Target lesions responsible for ACS were frequently composed of LCP; in addition, LCPs often were found in remote, nontarget areas. Both target and remote LCPs were more common in patients with ACS than in those with stable angina. Approximately one half of target lesions in stable patients were also composed of LCP.
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Affiliation(s)
- Ryan D. Madder
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
| | - James L. Smith
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
| | - Simon R. Dixon
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
| | - James A. Goldstein
- From the Frederik Meijer Heart and Vascular Institute, Spectrum Health System, Grand Rapids, MI (R.D.M.), and Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.L.S., S.R.D., J.A.G.)
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Dixon SR, Grines CL, Munir A, Madder RD, Safian RD, Hanzel GS, Pica MC, Goldstein JA. Analysis of target lesion length before coronary artery stenting using angiography and near-infrared spectroscopy versus angiography alone. Am J Cardiol 2012; 109:60-6. [PMID: 21962996 DOI: 10.1016/j.amjcard.2011.07.068] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
Lipid core plaque (LCP) can extend beyond the angiographic margins of a target lesion, potentially resulting in incomplete lesion coverage. We sought to compare the target lesion length using near-infrared spectroscopy (NIRS) combined with conventional coronary angiography versus angiography alone. NIRS was performed in 69 patients (75 lesions) undergoing native vessel percutaneous coronary intervention (LipiScan Coronary Imaging System). Chemograms were analyzed for the presence and location of LCP, either within or extending beyond, the angiographic margins of the target lesion. The target lesion length was measured by quantitative coronary angiography (QCA) and compared to the lesion length measured using QCA and NIRS. LCP was present in 50 target lesions (67%). In 42 lesions (84%), LCP was present only within the target lesion. In 8 lesions (16%) LCP extended beyond the angiographic margins of the lesion. Of these 8 lesions, 4 (8%) had LCP ≤5 mm from the margins, and 4 lesions (8%) had LCP >5 mm from the angiographic margins. The mean distance that the LCP extended beyond the angiographic lesion margin was 7 ± 4 mm (range 2 to 14). For these 8 lesions, the target lesion length with NIRS plus QCA was 28 ± 10 mm versus 21 ± 8 mm with QCA alone. In conclusion, patients undergoing coronary artery stenting could have LCP extending beyond the intended treatment margins as defined using QCA alone. This could have implications for stent length selection and optimal lesion coverage.
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Gurm HS, Dixon SR, Smith DE, Share D, Lalonde T, Greenbaum A, Moscucci M. Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions. J Am Coll Cardiol 2011; 58:907-14. [PMID: 21851878 DOI: 10.1016/j.jacc.2011.05.023] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/20/2011] [Accepted: 05/24/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between calculated creatinine clearance (CCC)-based contrast dose and renal complications in patients undergoing percutaneous coronary interventions (PCI). BACKGROUND Excess volumes of contrast media are associated with renal complications in patients undergoing cardiac procedures. Because contrast media are excreted by the kidney, we hypothesized that a dose estimation on the basis of CCC would provide a simple strategy to define a safe dose of contrast media. METHODS We assessed the association between CCC-based contrast dose and the risk of contrast-induced nephropathy (CIN) and need for in-hospital dialysis in 58,957 patients undergoing PCI and enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry from 2007 to 2008. Patients receiving dialysis at the time of the procedure were excluded. RESULTS The risk of CIN and nephropathy requiring dialysis (NRD) was directly associated with increasing contrast volume adjusted for renal function. The risk for CIN and NRD approached significance when the ratio of contrast dose/CCC exceeded 2 (adjusted odds ratio [OR] for CIN: 1.16, 95% confidence interval [CI]: 0.98 to 1.37, adjusted OR for NRD: 1.72, 95% CI: 0.9 to 3.27) and was dramatically elevated in patients exceeding a contrast to CCC ratio of 3 (adjusted OR for CIN: 1.46, 95% CI: 1.27 to 1.66, adjusted OR for NRD: 1.89, 95% CI: 1.21 to 2.94). CONCLUSIONS Our study supports the need for minimizing contrast dose in patients with renal dysfunction. A contrast dose on the basis of estimated renal function with a planned contrast volume restricted to less than thrice and preferably twice the CCC might be valuable in reducing the risk of CIN and NRD.
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Affiliation(s)
- Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
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Goldstein JA, Maini B, Dixon SR, Brilakis ES, Grines CL, Rizik DG, Powers ER, Steinberg DH, Shunk KA, Weisz G, Moreno PR, Kini A, Sharma SK, Hendricks MJ, Sum ST, Madden SP, Muller JE, Stone GW, Kern MJ. Detection of Lipid-Core Plaques by Intracoronary Near-Infrared Spectroscopy Identifies High Risk of Periprocedural Myocardial Infarction. Circ Cardiovasc Interv 2011; 4:429-37. [DOI: 10.1161/circinterventions.111.963264] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James A. Goldstein
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Brijeshwar Maini
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Simon R. Dixon
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Emmanouil S. Brilakis
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Cindy L. Grines
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - David G. Rizik
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Eric R. Powers
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Daniel H. Steinberg
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Kendrick A. Shunk
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Giora Weisz
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Pedro R. Moreno
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Annapoorna Kini
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Samin K. Sharma
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Michael J. Hendricks
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Steve T. Sum
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Sean P. Madden
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - James E. Muller
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Gregg W. Stone
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
| | - Morton J. Kern
- From the Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI (J.A.G., S.R.D., C.L.G.); Pinnacle Health, Moffitt Heart and Vascular Group, Wormleysburg, PA (B.M.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX (E.B.); Scottsdale Heart Group, Scottsdale Healthcare Hospital, Scottsdale, AZ (D.G.R.); Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (E.R.P., D.H.S.); the
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Dixon SR, Grines CL. The Year in Interventional Cardiology. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.01.027] [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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Maini B, Brilakis ES, Kim M, Hendricks MJ, Sum ST, Madden SP, Muller JE, Rizik D, Dixon SR. ASSOCIATION OF LARGE LIPID CORE PLAQUE DETECTED BY NEAR INFRARED SPECTROSCOPY WITH POST PERCUTANEOUS CORONARY INTERVENTION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61673-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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