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Cao D, Mehran R, Dangas GD, Chandiramani R, Sartori S, Roumeliotis A, Goel R, Nicolas J, Baber U, Stefanini GG, Kovacic J, Sweeny J, Krishnan P, Barman N, Sharma SK, Kini AS. ADDITIVE EFFECT OF MULTIPLE HIGH BLEEDING RISK CRITERIA IN PATIENTS UNDERGOING PCI. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kini AS, Okamoto N, Barman N, Vengrenyuk Y, Yasumura K, Chamaria S, Bhatheja S, Kapur V, Hasan C, Sweeny J, Baber U, Mehran R, Stone GW, Sharma SK. INCIDENCE AND PREDICTORS OF FUNCTIONALLY SIGNIFICANT SIDE BRANCH STENOSES IN CALCIFIED CORONARY LESIONS AFTER ROTATIONAL ATHERECTOMY AND CUTTING BALLOON ANGIOPLASTY: THE RANDOMIZED ORBID-FFR TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roumeliotis A, Cao D, Mehran R, Dangas G, Chandiramani R, Goel R, Blum M, Beyhoff N, Singleton R, Sartori S, Barman N, Khan A, Krishnan P, Kovacic J, Sweeny J, Baber U, Sharma S, Kini A. TCT-630 The Impact of Diabetes Mellitus in Patients Undergoing Percutaneous Coronary Intervention With a Drug Eluting Stent for Unprotected Left Main Stenosis. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cao D, Mehran R, Chandiramani R, Roumeliotis A, Goel R, Blum M, Sartori S, Singleton R, Stefanini G, Dangas G, Baber U, Khan A, Kovacic J, Sweeny J, Krishnan P, Barman N, Sharma S, Kini A. TCT-541 Validation of the Academic Research Consortium–High Bleeding Risk Criteria for Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Okamoto N, Vengrenyuk Y, Fuster V, Yasumura K, Samady H, Baber U, Barman N, Sweeny J, Krishnan P, Mehran R, Sharma S, Narula J, Kini A. TCT-831 Identification of High-Risk Plaques by Coronary Angiography: Confirmation of Computational Fluid Dynamics by Optical Coherence Tomography. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baber U, Mehran R, Seetharam K, Kovacic J, Khan A, Sweeny J, Melarcode-Krishnamoorthy P, Vengrenyuk Y, Dangas G, Sharma S, Kini A. TCT-635 Combined and Independent Impact of Diabetes Mellitus and Elevated C-Reactive Protein Levels on Risk for Death and MI Following PCI: Insights From a Large Single-Center Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Plitt A, Claessen BE, Sartori S, Baber U, Chandrasekhar J, Aquino M, Vijay P, Elsayed S, Kovacic JC, Sweeny J, Barman N, Moreno P, Krishnan P, Demopoulos A, Dangas G, Kini AS, Mehran R, Sharma SK. Impact of stent diameter on outcomes following percutaneous coronary intervention with second‐generation drug‐eluting stents: Results from a large single‐center registry. Catheter Cardiovasc Interv 2019; 96:558-564. [DOI: 10.1002/ccd.28488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 11/09/2022]
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Farhan S, Baber U, Vogel B, Aquino M, Giustino G, Chandrasekhar J, Sorrentino S, Guedeney P, Manzanilla G, Bunal N, Rassouli M, Barman N, Sweeny J, Khan A, Dangas G, Mehran R, Kini A, Sharma SK. Feasibility of measuring patient-reported health status at time of percutaneous coronary intervention: Results from a single-center quality-improvement initiative. Eur J Prev Cardiol 2019; 27:2183-2186. [PMID: 31480872 DOI: 10.1177/2047487319874150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Okamoto N, Vengrenyuk Y, Bhatheja S, Chamaria S, Khan A, Gupta E, Kapur V, Barman N, Hasan C, Sweeny J, Baber U, Mehran R, Narula J, Sharma SK, Kini AS. Stent Expansion and Endothelial Shear Stress in Bifurcation Lesions. Circ Cardiovasc Interv 2019; 12:e007911. [PMID: 31195824 DOI: 10.1161/circinterventions.119.007911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guedeney P, Claessen BE, Baber U, Camaj A, Sorrentino S, Aquino M, Blum M, Chandiramani R, Goel R, Elsayed S, Kovacic JC, Sweeny J, Barman N, Moreno P, Dangas GD, Kini A, Sharma S, Mehran R. Temporal Trends in Statin Prescriptions and Residual Cholesterol Risk in Patients With Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2019; 123:1788-1795. [PMID: 30955866 DOI: 10.1016/j.amjcard.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/24/2022]
Abstract
Intensive low-density lipoprotein cholesterol (LDL-C) reduction with statins is recommended after elective percutaneous coronary intervention (PCI). We aimed to evaluate adherence to guideline-recommended statin therapy (GRST) and the rate of residual cholesterol risk (RCR) at follow-up after elective PCI. All patients who underwent elective PCI between January 2010 and May 2016 were prospectively included in this single-center study. GRST was defined as high-intensity statin (HIS) therapy for patients ≤75 years old and moderate-intensity statin (MIS) or HIS therapy for patients >75 years. RCR at follow-up was defined as <50% decrease in LDL-C with HIS or <30% with MIS for statin-naïve patients and as LDL-C >70 mg/dL for nonstatin-naïve patients. A total of 2,653 patients were included, with 1,304 (49.2%) discharged with GRST. There was a significant increase in the number of patients discharged with GRST over time from 44.2% in 2010 to 63.0% in 2016 (p <0.001). Conversely, RCR at follow-up was present in 1,120 patients (42.2%) overall and remained stable over time. Risk factors of RCR at follow-up were female gender (odds ratio [OR]: 1.38; 95% confidence interval [CI] 1.13 to 1.70), previous myocardial infarction (OR: 1.37; 95% CI 1.12 to 1.64), smoking (OR: 1.30; 95% CI 1.01 to 1.67), higher LDL-C level at baseline (OR: 1.22; 95% CI 1.18 to 1.25). The presence of RCR was associated with an increased adjusted risk of death within 1 year of the second LDL-C measurement (adjHR: 2.78; 95% CI 1.15 to 6.67). In conclusion, although the rate of GRST at discharge has improved significantly over time in patients who underwent elective PCI, the prevalence of RCR at follow-up has not changed appreciably suggesting that further implementation of guidelines as well as novel or more intensive pharmacotherapy may be warranted.
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Farhan S, Vogel B, Baber U, Sartori S, Aquino M, Chandrasekhar J, Sorrentino S, Giustino G, Sharma M, Guedeney P, Rohla M, Bhandari R, Barman N, Sweeny J, Dangas G, Mehran R, Kini A, Sharma S. Calculated Serum Osmolality, Acute Kidney Injury, and Relationship to Mortality after Percutaneous Coronary Intervention. Cardiorenal Med 2019; 9:160-167. [PMID: 30844810 DOI: 10.1159/000494807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the associations between serum osmolality (sOsmo) and acute kidney injury (AKI) as well as short- and long-term mortality in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are limited. OBJECTIVES To investigate the association between sOsmo and development of AKI and clinical outcomes in patients undergoing PCI. METHODS We investigated 1,927 consecutive patients undergoing PCI from the registry of a single center. Patients were divided into quartiles according to sOsmo at admission (Q1-Q4). sOsmo was calculated using the following equation: (1.86 × serum sodium [mmol/L]) + (glucose [mg/dL] / 18) + (blood urea nitrogen [mg/dL] / 2.8) + 9. The primary endpoint was AKI, per Kidney Disease: Improving Global Outcomes (KDIGO) definition. The secondary endpoints were 30-day and 1-year all-cause mortality. RESULTS Patients with the highest sOsmo (Q4) were older and more likely female, with significantly more cardiovascular risk factors and comorbidities compared to those with lower sOsmo (Q1-Q3). Incidence of AKI was highest in Q4 and lowest in Q2. In the multivariate logistic regression model, high sOsmo independently predicted the development of AKI (OR 2.00, 95% CI 1.26-3.19, p = 0.003). Patients with Q4 had a higher risk of 1-year mortality compared to patients with Q2 (HR 2.11, 95% CI 1.10-4.15; p = 0.031), but not after adding AKI to the multivariate model (HR 1.71, 95% CI 0.87-3.39; p = 0.12). CONCLUSION sOsmo is a valid and easily obtainable predictor of AKI after PCI. High sOsmo is associated with increased risk of AKI and 1-year mortality in patients undergoing PCI. Further research is warranted to clarify whether the use of an sOsmo-directed hydration protocol might reduce the incidence of AKI in patients undergoing PCI.
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Camaj A, Giustino G, Claessen B, Hinohara T, Baber U, Aquino M, Guedeney P, Sorrentino S, Kalkman D, Vogel B, Farhan S, Shah S, Barman N, Vijay P, Kovacic J, Sweeny J, Dangas G, Kini A, Mehran R, Sharma S. EFFECT OF SYSTEMIC INFLAMMATION ON OUTCOMES AFTER COMPLEX PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hinohara TT, Giustino G, Baber U, Camaj A, Aquino M, Claessen B, Farhan S, Shah S, Barman N, Vijay P, Kovacic J, Sweeny J, Dangas G, Kini A, Mehran R, Sharma S. IMPACT OF PERCUTANEOUS CORONARY INTERVENTION COMPLEXITY IN REAL-WORLD PRACTICE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31881-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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64
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Blum M, Guedeney P, Claessen B, Aquino M, Kalkman D, Sorrentino S, Chandiramani R, Elsayed S, Goel R, Vogel B, Barman N, Sweeny J, Kovacic J, Kini A, Dangas G, Baber U, Sharma S, Mehran R. RESIDUAL INFLAMMATORY RISK IN PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Katta N, Baber U, Barman N, Khan A, Sweeny J, Patel N, Patel R, Hasan C, Mehran R, Sharma S, Kini A. SAFETY AND EFFICACY OF THE BIOABSORBABLE POLYMER EVEROLIMUS ELUTING STENTS COMPARED TO THE 2ND GENERATION DURABLE POLYMER EVEROLIMUS ELUTING STENTS IN COMPLEX CORONARY LESIONS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Okamoto N, Vengrenyuk Y, Bhatheja S, Chamaria S, Khan A, Gupta E, Kapur V, Barman N, Hasan C, Sweeny J, Baber U, Mehran R, Narula J, Sharma S, Kini A. STENT EXPANSION AND ENDOTHELIAL SHEAR STRESS IN BIFURCATION LESION: COMPARISON OF KISSING BALLOON INFLATION AND PROXIMAL OPTIMIZING TECHNIQUE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guedeney P, Claessen B, Kalkman D, Aquino M, Sorrentino S, Blum M, Giustino G, Farhan S, Vogel B, Sartori S, Montalescot G, Sweeny J, Kovacic J, Barman N, Dangas G, Kini A, Baber U, Sharma S, Mehran R. IMPACT OF RESIDUAL INFLAMMATORY RISK IN PATIENTS WITH LOW LDL-CHOLESTEROL UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHT FROM A LARGE SINGLE-CENTER REGISTRY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Murphy J, Baber U, Aquino M, Barman N, Sweeny J, Mehran R, Khan A, Hasan C, Kapur V, Dangas G, Patel N, Sharma S, Kini A. SYNERGISTIC IMPACT OF CORONARY CALCIFICATION AND BIFURCATION TARGET LESIONS ON ADVERSE CARDIOVASCULAR EVENTS FOLLOWING PCI: INSIGHTS FROM A LARGE SINGLE-CENTER PCI REGISTRY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Guedeney P, Baber U, Claessen B, Aquino M, Camaj A, Sorrentino S, Vogel B, Farhan S, Faggioni M, Chandrasekhar J, Kalkman DN, Kovacic JC, Sweeny J, Barman N, Moreno P, Vijay P, Shah S, Dangas G, Kini A, Sharma S, Mehran R. Temporal trends, determinants, and impact of high-intensity statin prescriptions after percutaneous coronary intervention: Results from a large single-center prospective registry. Am Heart J 2019; 207:10-18. [PMID: 30404046 DOI: 10.1016/j.ahj.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting. METHODS All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg. RESULTS A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P < .001), with a stepwise increase each year after 2013. Predictors of HIS prescriptions included ST-segment elevation myocardial infarction/non-ST-segment elevation myocardial infarction (odds ratio [OR] 4.60, 95% CI 3.98-5.32, P < .001) and unstable angina (OR 1.31, 95% CI 1.19-1.45, P < .001) as index event, prior myocardial infarction (OR 1.48, 95% CI 1.34-1.65, P < .001), and co-prescription of β-blocker (OR 1.26, 95% CI 1.12-1.43, P < .001). Conversely, statin treatment at baseline (OR 0.86, 95% CI 0.77-0.96, P = .006), Asian races (OR 0.73, 95% CI 0.65-0.83, P < .001), and older age (OR 0.90, 95% CI 0.88-0.92, P < .001) were associated with reduced HIS prescriptions. There was no significant association between HIS prescriptions and 1-year rates of death, myocardial infarction, or target-vessel revascularization (adjusted hazard ratio 0.98, 95% CI 0.84-1.15, P = .84), although there was a trend toward reduced mortality (adjusted hazard ratio 0.71, 95% CI 0.50-1.00, P = .05). CONCLUSION Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.
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Kalkman DN, Aquino M, Claessen BE, Baber U, Guedeney P, Sorrentino S, Vogel B, de Winter RJ, Sweeny J, Kovacic JC, Shah S, Vijay P, Barman N, Kini A, Sharma S, Dangas GD, Mehran R. Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions. Eur Heart J 2018; 39:4101-4108. [PMID: 30358832 DOI: 10.1093/eurheartj/ehy633] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/22/2018] [Indexed: 11/14/2022] Open
Abstract
Aims It remains unknown what percentage of patients treated with percutaneous coronary artery intervention (PCI) have high residual inflammatory risk (RIR). Moreover, the impact of RIR on clinical outcomes has not been established. The objective of this study is to determine the prevalence of patients with persistent high levels of inflammation after PCI and to evaluate clinical outcomes according to inflammatory response. Methods and results This is a retrospective cohort study assessing patients undergoing PCI between 2009 and 2016 with serial inflammatory status assessment from a large, prospective, and single-centre PCI registry. Assessment of inflammation status with at least two high sensitive C-reactive protein (hsCRP) measurements at baseline and follow-up with >4 weeks apart. High RIR was defined as an hsCRP≥ 2 mg/L. Patients were divided into four groups: persistent high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistent low RIR. The primary endpoint was all-cause mortality at 1 year follow-up. Occurrence of myocardial infarction (MI) was assessed as secondary outcome. Seven thousand and twenty-six patients were identified with serial hsCRP measurements (30.8% of all PCI patients). Of these patients 2654 (38%) had persistent high RIR, 719 patients (10%) had increased RIR, 1088 patients (15%) had attenuated RIR, and persistent low RIR was seen in 2565 patients (37%). All-cause mortality at 1 year was 2.6% in patients with persistent high RIR, compared with 1.0% in increased RIR, 0.3% in attenuated RIR, and 0.7% in persistent low RIR patients, P < 0.01. MI at 1 year was observed in 7.5% of persistent high RIR, compared with 6.4% in increased RIR, 4.6% in attenuated RIR, and 4.3% in persistent low RIR, P < 0.01. In an adjusted model, including accounting for diabetes mellitus, acute coronary syndrome, and baseline low-density lipoprotein, results were sustained. Conclusion Persistent high RIR is observed frequently in patients undergoing PCI. In these patients, significantly higher all-cause mortality and MI rates are observed at 1 year follow-up. Residual inflammatory risk in patients undergoing PCI should be identified and treatment options should be further explored.
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Barman N, Okamoto N, Ueda H, Chamaria S, Bhatheja S, Vengrenyuk Y, Gupta E, Sweeny J, Kapur V, Hasan C, Baber U, Moreno P, Sharma S, Kini AS. Predictors of side branch compromise in calcified bifurcation lesions treated with orbital atherectomy. Catheter Cardiovasc Interv 2018; 94:45-52. [DOI: 10.1002/ccd.27992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/29/2018] [Indexed: 11/07/2022]
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Sorrentino S, Baber U, Claessen BE, Camaj A, Vogel B, Sartori S, Guedeney P, Chandrasekhar J, Farhan S, Barman N, Sweeny J, Giustino G, Dangas G, Kini A, Sharma S, Mehran R. Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention. Thromb Haemost 2018; 118:1997-2005. [PMID: 30312975 DOI: 10.1055/s-0038-1673687] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. METHODS We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. RESULTS In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk. CONCLUSION Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.
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Camaj A, Giustino G, Baber U, Aquino M, Kalkman D, Shah S, Barman N, Vijay P, Kovacic J, Sorrentino S, Sweeny J, Dangas G, Kini A, Sharma S, Mehran R. P1652Effect of systemic inflammation and coronary artery disease complexity on outcomes after percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kalkman DN, Aquino M, Baber U, Vogel B, Sorrentino S, Guedeney P, Sweeny J, Kovacic J, Shah S, Vijay P, Barman N, Sharma S, Kini A, Dangas G, Mehran R. P6435Impact of persistent high C-reactive protein levels on all-cause mortality in patients after percutaneous coronary interventions. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Okamoto N, Ueda H, Yoshimura T, Chamaria S, Bhatheja S, Vengrenyuk Y, Rabiei S, Barrientos Y, Kapur V, Barman N, Sweeny J, Baber U, Mehran R, Sharma SK, Kini AS. Real-World Bioresorbable Vascular Scaffold Experience Compared With Second-Generation Metallic Drug-Eluting Stents in Complex Coronary Lesions. THE JOURNAL OF INVASIVE CARDIOLOGY 2018; 30:251-255. [PMID: 29656280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of the study was to compare the acute outcomes of Absorb bioresorbable vascular scaffolds (BVS) and second-generation drug-eluting stent (DES) implantation in routine clinical practice. There is a paucity of data regarding BVS use in a real-world patient population. METHODS The study population comprised 40 consecutive patients who underwent percutaneous coronary intervention (PCI) with BVS implantation at a tertiary-care center in New York, New York between July and December of 2016. An optimal implantation technique including adequate lesion preparation, mandatory postdilation, and optical coherence tomography (OCT) imaging was used in all cases. De novo lesions treated with BVS were compared to lesions treated with DES matched by OCT calcium arc, scaffold/stent size, use of atherectomy device, and lesion postdilation. Acute lumen gain, minimal device area, malapposition, eccentricity, and symmetry index were assessed using OCT. RESULTS We analyzed OCT images of 40 BVS cases and 40 matching DES cases from 35 and 40 patients, respectively. Compared to the DES group, the BVS group demonstrated similar acute lumen gain, minimal scaffold/stent area, eccentricity index, and symmetry index after PCI. There were fewer malapposed struts detected after BVS implantation; however, malapposition distance and length were not different between the groups. CONCLUSION BVS implantation in a real-world patient population with optimal implantation technique resulted in similar stent expansion and better strut apposition compared to DES implantation.
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