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Abbasciano RG, Layton GR, Torre S, Abbaker N, Copperwheat A, Lucarelli C, Bhandari S, Nijjer S, Mikhail G, Casula R, Zakkar M, Viviano A. Fractional flow reserve and instantaneous wave-free ratio in coronary artery bypass grafting: a meta-analysis and practice review. Front Cardiovasc Med 2024; 11:1348341. [PMID: 38516003 PMCID: PMC10955066 DOI: 10.3389/fcvm.2024.1348341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive methods to assess the functional significance of intermediate severity coronary lesions. Both indexes have been extensively validated in clinical trials in guiding revascularisation in patients with stable ischaemic heart disease undergoing percutaneous coronary intervention (PCI) with improved clinical outcomes. However, the role of these tools in coronary artery bypass grafting (CABG) is less clear. Methods A meta-analysis of randomised trials and observational studies was carried out to help in determining the optimal strategy for assessing lesion severity and selecting graft targets in patients undergoing CABG. Electronic searches were carried out on Embase, MEDLINE, and Web of Science. A group of four authors independently screened and then assessed the retrieved records. Cochrane's Risk of Bias and Robins-I tools were used for bias assessment. A survey was conducted among surgeons and cardiologists to describe current attitudes towards the preoperative use of functional coronary investigations in practice. Results Clinical outcomes including mortality at 30 days, perioperative myocardial infarction, number of grafts, incidence of stroke, rate of further need for revascularisation, and patient-reported quality of life did not differ in CABG guided by functional testing from those guided by traditional angiography.The survey revealed that in half of the surgical and cardiology units functional assessment is performed in CABG patients; there is a general perception that functional testing has improved patient care and its use would clarify the role of moderate coronary lesions that often need multidisciplinary rediscussions; moderate stenosis are felt to be clinically relevant; and anatomical considerations need to be taken into account together with functional assessment. Conclusions At present, the evidence to support the routine use of functional testing in intermediate lesions for planning CABG is currently insufficient. The pooled data currently available do not show an increased risk in mortality, myocardial injury, and stroke in the FFR/iFR-guided group. Further trials with highly selected populations are needed to clarify the best strategy. Systematic Review Registration ClinicalTrials.gov, identifier (CRD42023414604).
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Affiliation(s)
- R. G. Abbasciano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G. R. Layton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Torre
- Cardiac Surgery Unit, Giaccone Hospital, Palermo, Italy
| | - N. Abbaker
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A. Copperwheat
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - C. Lucarelli
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Bhandari
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Nijjer
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - G. Mikhail
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R. Casula
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M. Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - A. Viviano
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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2
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Petrovic M, Spirito A, Sartori S, Vogel B, Tchetche D, Petronio AS, Mehilli J, Lefevre T, Presbitero P, Capranzano P, Pileggi B, Iadanza A, Sardella G, van Mieghem NM, Meliga E, Feng Y, Dumonteil N, Cohen R, Fraccaro C, Trabattoni D, Mikhail G, Ferrer-Gracia MC, Naber C, Sharma SK, Watanabe Y, Morice MC, Dangas GD, Chieffo A, Mehran R. Prognostic Impact of Prefrailty and Frailty in Women Undergoing TAVR: Insights From the WIN-TAVI Registry. Can J Cardiol 2024; 40:457-467. [PMID: 37923124 DOI: 10.1016/j.cjca.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The risks of prefrail and frail women undergoing transcatheter aortic valve replacement (TAVR) have not been fully examined. The aim of the analysis was to assess the prognostic impact of prefrailty and frailty in women undergoing TAVR. METHODS Women at intermediate or high surgical risk with severe aortic stenosis undergoing TAVR from the prospective multicentre WIN-TAVI (Women's International Transcatheter Aortic Valve Implantation) registry were stratified based on the number of Fried frailty criteria (weight loss, exhaustion, low physical activity, slow gait, weakness) met: nonfrail (no criteria), prefrail (1 or 2 criteria), or frail (3 or more criteria). The primary outcome at 1 year was the Valve Academic Research Consortium 2 (VARC-2) efficacy end point, a composite of mortality, stroke, myocardial infarction, hospitalisation for valve-related symptoms or heart failure, and valve-related dysfunction; secondary outcomes included the composite of VARC-2 life-threatening or major bleeding. RESULTS Out of 1019 women, 297 (29.1%) met at least 1 frailty criterion: 264 (25.9%) had prefrailty and 33 (3.2%) frailty. The 1-year risk of the primary outcome was significantly higher in prefrail and frail (20.2%) than in nonfrail (14.9%) women (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.07-2.12). The risk of VARC-2 life-threatening or major bleeding was higher in prefrail or frail (19.9%) than in nonfrail (10.0%) women (aHR 2.06, 95% CI 1.42-2.97). These risks were consistently increased in the prefrail and frail groups assessed separately. CONCLUSIONS In women undergoing TAVR, the presence of prefrailty or frailty conferred an increased risk of the VARC-2 efficacy end point and of VARC-2 life-threatening or major bleeding.
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Affiliation(s)
- Marija Petrovic
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University and German Centre for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Thierry Lefevre
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | - Piera Capranzano
- Cardiology, Policlinico Hospital, University of Catania, Catania, Italy
| | - Brunna Pileggi
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiopneumonology, Heart Institute of the University of São Paulo, São Paulo, Brazil
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Gennaro Sardella
- Policlinico Umberto I "Sapienza," University of Rome, Rome, Italy
| | | | | | - Yihan Feng
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Rebecca Cohen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ghada Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | - Christoph Naber
- Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany
| | - Samin K Sharma
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Marie-Claude Morice
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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3
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Chick W, Alkhalil M, Egred M, Gorog DA, Edwards R, Das R, Abdeldayem T, Ibrahim O, Malik I, Mikhail G, Zaman A, Farag M. A Systematic Review and Meta-Analysis of the Clinical Outcomes of Isolated Tricuspid Valve Surgery. Am J Cardiol 2023; 203:414-426. [PMID: 37531685 DOI: 10.1016/j.amjcard.2023.07.006] [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: 02/12/2023] [Revised: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
Patients with isolated tricuspid valve (TV) disease have poor prognosis with no consensus on their management. Transcatheter TV intervention is emerging as a valid option in patients with prohibitive surgical risk. We analyzed studies of patients who underwent isolated TV surgery to identify the features associated with successful clinical outcomes. We performed a systematic review and meta-analysis of studies reporting clinical outcomes of isolated surgical TV intervention, namely TV repair, TV replacement with a bioprosthetic valve (TVR-B), or TV replacement with a mechanical valve (TVR-M). Twenty-seven studies involving 10,478 patients (4,931 TV repair, 3,821 TVR-B, and 1,713 TVR-M) were included. Early mortality occurred in 9% and did not differ between TV surgical approaches. Late mortality was 27% at a median follow-up of 4 (3 to 6) years and was significantly higher for all-TVR (30% vs 25%, rate ratio 1.18, 95% confidence interval 1.05 to 1.31, p = 0.004) and TVR-B (28% vs 24%, rate ratio 1.15, 95% confidence interval 1.02 to 1.30, p = 0.02) compared with TV repair. Late mortality did not differ between TVR-B and TVR-M. Across all studies, early complications included bleeding (7.4%), acute kidney injury (18.7%), permanent pacemaker (13.7%), cerebrovascular accidents (1.2%), and infection (8.9%). Late clinical outcomes included reintervention (3.7%), structural valve deterioration (2.4%), valve thrombosis (2.6%), and TV regurgitation recurrence after 1 year (15.0%). In conclusion, in isolated TV surgeries, TV repair has favorable long-term mortality compared with TV replacement. This supports the development and refinement of transcatheter TV repair approaches. Future research is recommended to provide comparative data for various transcatheter TV interventions.
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Affiliation(s)
- William Chick
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Diana A Gorog
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom; Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, United Kingdom
| | - Richard Edwards
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Rajiv Das
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Tarek Abdeldayem
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Osama Ibrahim
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Iqbal Malik
- Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Mohamed Farag
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, United Kingdom.
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4
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van Bergeijk KH, Wykrzykowska JJ, Sartori S, Snyder C, Vogel B, Tchetche D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer-Gracia MC, Naber C, Kievit P, Sharma SK, Morice MC, Dangas GD, Chieffo A, Voors AA, Mehran R. Pre-procedural oral anticoagulant use is associated with cardiovascular events in women after transcatheter aortic valve replacement: An analysis from the WIN-TAVI cohort. Int J Cardiol 2023; 372:40-45. [PMID: 36455701 DOI: 10.1016/j.ijcard.2022.11.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become an accepted treatment for patients with severe aortic stenosis (AS). Predicting which patients are at risk for adverse clinical outcomes after TAVI remains difficult, especially in women. AIM To identify predictors of adverse events in the WIN-TAVI cohort. METHODS The WIN-TAVI study is an observational registry of 1019 women undergoing TAVI for severe symptomatic AS. Follow-up was 1 year. The primary outcome was defined according to VARC-2: a composite of mortality, stroke, myocardial infarction or hospitalization for valve-related symptoms or heart failure. The secondary outcome was a composite of cardiovascular mortality or hospitalization for valve-related symptoms or heart failure. RESULTS We included 1019 women with severe AS (mean age of 82.5 ± 6.3 years). At 1 year, 16.4% of the patients experienced the primary endpoint and 12.6% the secondary endpoint. The use of oral anticoagulants (OAC) was the strongest independent predictor of the primary outcome (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.079-2.106, p = 0.016). Independent predictors of the secondary endpoint were age (aHR 1.04 per year, 95% CI 1.01-1.074, p = 0.016) and use of OAC (aHR: 1.79, 95% CI 1.24-2.60, p = 0.002). OAC use was not associated with higher bleeding risk. CONCLUSION Pre-procedural use of OAC was the strongest predictor of adverse outcomes during 1-year follow-up, likely reflecting a combination of high-risk factors and comorbidities, but was not related to increased bleeding risk.
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Affiliation(s)
- Kees H van Bergeijk
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joanna J Wykrzykowska
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | | | - Julinda Mehilli
- University Hospital Munich, Ludwig-Maximilians University and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | | | | | | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Gennaro Sardella
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | - Christoph Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Peter Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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5
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Foley MJ, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee RK, Sen S. CRT-700.27 Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.288] [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: 02/22/2023]
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Khokhar AA, Ponticelli F, Zlahoda-Huzior A, Zakrzewski P, Mikhail G, Dudek D, Giannini F. Coronary access techniques following ACURATE neo2 implantation in surgical bioprosthesis. EUROINTERVENTION 2022; 18:820-821. [PMID: 35708304 PMCID: PMC9725048 DOI: 10.4244/eij-d-22-00149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Arif A Khokhar
- Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Digital Innovations & Robotics Hub, Krakow, Poland
| | | | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement & Electronics, AGH University of Science & Technology, Krakow, Poland
| | | | - Ghada Mikhail
- Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
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Khokhar AA, Giannini F, Zlahoda‐Huzior A, Mikhail G, Dudek D. Coronary access after ACURATE neo2 implantation for valve-in-valve TAVR: Insights from ex vivo simulations. Catheter Cardiovasc Interv 2022; 100:662-666. [PMID: 36116020 PMCID: PMC9826017 DOI: 10.1002/ccd.30367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Arif A. Khokhar
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
- Digital Innovations & Robotics HubKrakowPoland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
| | - Adriana Zlahoda‐Huzior
- Digital Innovations & Robotics HubKrakowPoland
- Department of Measurement and ElectronicsAGH University of Science and TechnologyKrakowPoland
| | - Ghada Mikhail
- Department of CardiologyImperial College Healthcare NHS TrustLondonUK
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care & ResearchMaria Cecilia HospitalCotignolaItaly
- Institute of CardiologyJagiellonian University Medical CollegeKrakowPoland
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8
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Wöhrle J, Gilard M, Didier R, Kini A, Tavenier AH, Tijssen JG, Sartori S, Snyder C, Nicolas J, Seeger J, Landmesser U, Tarantini G, Asgar A, Möllmann H, Thiele H, Capranzano P, Reimers B, Stefanini G, Moreno R, Petronio AS, Mikhail G, Kapadia S, Hildick-Smith D, Hengstenberg C, Mehran R, Windecker S, Dangas GD. Outcomes After Transcatheter Aortic Valve Implantation in Men Versus Women. Am J Cardiol 2022; 180:108-115. [DOI: 10.1016/j.amjcard.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
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9
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Foley M, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee R, Sen S. Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. J Soc Cardiovasc Angiogr Interv 2022; 1:100349. [PMID: 35992189 PMCID: PMC9337994 DOI: 10.1016/j.jscai.2022.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 01/09/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis who are at a moderate or higher surgical risk. Stroke is a recognised and serious complication of TAVR, and it is important to identify patients at higher stroke risk. This study aims to discover if aortic valve calcium score calculated from pre-TAVR computed tomography is associated with acute stroke in TAVR patients. Methods We conducted a retrospective, observational cohort study of 433 consecutive patients undergoing TAVR between January 2017 and December 2019 at the Hammersmith Hospital. Results This cohort had a median age of 83 years (interquartile range, 78-87), and 52.7% were male. Fifty-two patients (12.0%) had a history of previous stroke or transient ischemic attack. Median aortic valve calcium score was 2145 (interquartile range, 1427-3247) Agatston units. Twenty-two patients had a stroke up to the time of discharge (5.1%). In a logistic regression model, aortic valve calcium score was significantly associated with acute stroke (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.01-1.53; P = .02). Acute stroke was also significantly associated with peripheral arterial disease (OR, 4.32; 95% CI, 1.65-10.65; P = .0018) and a longer procedure time (OR, 1.01; 95% CI, 1.00-1.02; P = .0006). Conclusions Aortic valve calcium score from pre-TAVR computed tomography is an independent risk factor for acute stroke in the TAVR population. This is an additional clinical value of the pre-TAVR aortic valve calcium score and should be considered when discussing periprocedural stroke risk.
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Affiliation(s)
- Michael Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kerry Hall
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Manisha Gandhi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samir Mahboobani
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Okafor
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haseeb Rahman
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nearchos Hadjiloizou
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal Malik
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bushra Rana
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Edward Barden
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Anderson
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Afoke
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
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Giannini F, Khokhar AA, Curio J, Zlahoda-Huzior A, Mikhail G, Dudek D. Coronary Access and PCI After Chimney-Stenting During Self-Expanding Transcatheter Aortic Valve Replacement in Surgical Bioprosthesis. JACC Cardiovasc Interv 2022; 15:1585-1589. [PMID: 35717397 DOI: 10.1016/j.jcin.2022.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy.
| | - Arif A Khokhar
- Cardiology Service, Imperial College Healthcare NHS Trust, London, United Kingdom; Digital Innovations and Robotics Hub, Krakow, Poland
| | - Jonathan Curio
- Department of Cardiology, Campus Benjamin Franklin, Charité University Medical Care, Berlin, Germany
| | - Adriana Zlahoda-Huzior
- Digital Innovations and Robotics Hub, Krakow, Poland; Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Ghada Mikhail
- Cardiology Service, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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11
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Pivato CA, Cao D, Spirito A, Sartori S, Nicolas J, Chiarito M, Snyder C, Mehilli J, Lefèvre T, Stefanini GG, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Vogel B, Sardella G, Van Mieghem NM, Nardin M, Tavenier AH, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Sharma S, Ferrer MC, Naber C, Kievit P, Baber U, Petronio AS, Morice MC, Chieffo A, Dangas G, Mehran R. Impact of Small Valve Size on 1-Year Outcomes After Transcatheter Aortic Valve Implantation in Women (from the WIN-TAVI Registry). Am J Cardiol 2022; 172:73-80. [PMID: 35461697 DOI: 10.1016/j.amjcard.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
Although most patients with small aortic annulus are women, there is paucity of data on the prognostic impact of small aortic prosthesis in women who underwent transcatheter aortic valve implantation (TAVI). Therefore, we aimed to evaluate the impact of small valve size on 1-year clinical outcomes after TAVI in women. The Women's INternational Transcatheter Aortic Valve Implantation is an all-women registry evaluating patients with severe aortic stenosis who underwent TAVI. Based on the size of the aortic bioprosthesis implanted, women were stratified into small (≤23 mm) and nonsmall (>23 mm) valve. The primary efficacy endpoint was the Valve Academic Research Consortium-2 composite of all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up. Of 934 women who underwent TAVI, 388 (41.5%) received a small valve. Women with a small valve size had a lower body mass index, lower surgical risk scores, were less likely to suffer from atrial fibrillation, less often required postdilation and had a lower rate of residual aortic regurgitation grade ≥2. The occurrence of the Valve Academic Research Consortium-2 efficacy endpoint was similar between women treated with small and nonsmall valve (16.0% vs 16.3%, p = 0.881; adjusted hazard ratio 1.34, 95% confidence interval 0.90 to 2.00). Likewise, there were no significant differences in the occurrence of other secondary endpoints after multivariable adjustment. In conclusion, women with severe aortic stenosis who underwent TAVI with the implantation of a small valve bioprosthesis had similar 1-year outcomes as those receiving a nonsmall bioprosthesis.
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Affiliation(s)
- Carlo A Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julinda Mehilli
- Department of Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Thierry Lefèvre
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | | | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Alessandro Iadanza
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne H Tavenier
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nicholas Dumonteil
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Chiara Fraccaro
- Department of Cardiology, University of Padova, Padova, Italy
| | - Daniela Trabattoni
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Ghada Mikhail
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria Cruz Ferrer
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany
| | - Peter Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna S Petronio
- Department of Cardiology, AOUP Cisanello, University Hospital, Pisa, Italy
| | - Marie C Morice
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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12
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Cook CM, Howard JP, Ahmad Y, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, Stathogiannis KE, de Waard GA, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary syndromes. Int J Cardiol 2021; 342:7-14. [PMID: 34358553 DOI: 10.1016/j.ijcard.2021.07.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/02/2021] [Revised: 07/04/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Adenosine hyperemia is an integral component of the physiological assessment of obstructive coronary artery disease in patients with chronic coronary syndrome (CCS). The aim of this study was to compare systemic, coronary and microcirculatory hemodynamics between intravenous (IV) adenosine hyperemia versus physical exercise stress in patients with CCS and coronary stenosis. METHODS Twenty-three patients (mean age, 60.6 ± 8.1 years) with CCS and single-vessel coronary stenosis underwent cardiac catheterization. Continuous trans-stenotic coronary pressure-flow measurements were performed during: i) IV adenosine hyperemia, and ii) physical exercise using a catheter-table-mounted supine ergometer. Systemic, coronary and microcirculatory hemodynamic responses were compared between IV adenosine and exercise stimuli. RESULTS Mean stenosis diameter was 74.6% ± 10.4. Median (interquartile range) FFR was 0.54 (0.44-0.72). At adenosine hyperemia versus exercise stress, mean aortic pressure (Pa, 91 ± 16 mmHg vs 99 ± 15 mmHg, p < 0.0001), distal coronary pressure (Pd, 58 ± 21 mmHg vs 69 ± 24 mmHg, p < 0.0001), trans-stenotic pressure ratio (Pd/Pa, 0.63 ± 0.18 vs 0.69 ± 0.19, p < 0.0001), microvascular resistance (MR, 2.9 ± 2.2 mmHg.cm-1.sec-1 vs 4.2 ± 1.7 mmHg.cm-1.sec-1, p = 0.001), heart rate (HR, 80 ± 15 bpm vs 85 ± 21 bpm, p = 0.02) and rate-pressure product (RPP, 7522 ± 2335 vs 9077 ± 3200, p = 0.0001) were all lower. Conversely, coronary flow velocity (APV, 23.7 ± 9.5 cm/s vs 18.5 ± 6.8 cm/s, p = 0.02) was higher. Additionally, temporal changes in Pa, Pd, Pd/Pa, MR, HR, RPP and APV during IV adenosine hyperemia versus exercise were all significantly different (p < 0.05 for all). CONCLUSIONS In patients with CCS and coronary stenosis, invasive hemodynamic responses differed markedly between IV adenosine hyperemia versus physical exercise stress. These differences were observed across systemic, coronary and microcirculatory hemodynamics.
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Affiliation(s)
- Christopher M Cook
- Imperial College London, London, UK; Essex Cardiothoracic Centre, Basildon, UK.
| | | | | | | | | | - Gerald J Clesham
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | - Kare H Tang
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | | | | | - John R Davies
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | | | | | | | | | | | - Firas Al-Janabi
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | | | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
| | - Reto Gamma
- Essex Cardiothoracic Centre, Basildon, UK
| | | | | | | | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK
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13
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Naderi H, Robinson S, Swaans MJ, Bual N, Cheung WS, Reid L, Shun-Shin M, Asaria P, Pabari P, Cole G, Kanaganayagam GS, Sutaria N, Bellamy M, Fox K, Nihoyannopoulos P, Petraco R, Al-Lamee R, Nijjer SS, Sen S, Ruparelia N, Baker C, Mikhail G, Malik I, Khamis R, Varnava A, Francis D, Mayet J, Rana B. Adapting the role of handheld echocardiography during the COVID-19 pandemic: A practical guide. Perfusion 2021; 36:547-558. [PMID: 33427055 DOI: 10.1177/0267659120986532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The COVID-19 pandemic has altered our approach to inpatient echocardiography delivery. There is now a greater focus to address key clinical questions likely to make an immediate impact in management, particularly during the period of widespread infection. Handheld echocardiography (HHE) can be used as a first-line assessment tool, limiting scanning time and exposure to high viral load. This article describes a potential role for HHE during a pandemic. We propose a protocol with a reporting template for a focused core dataset necessary in delivering an acute echocardiography service in the setting of a highly contagious disease, minimising risk to the operator. We cover the scenarios typically encountered in the acute cardiology setting and how an expert trained echocardiography team can identify such pathologies using a limited imaging format and include cardiac presentations encountered in those patients acutely unwell with COVID-19.
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Affiliation(s)
- Hafiz Naderi
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Nina Bual
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Wing-See Cheung
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Laura Reid
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Matthew Shun-Shin
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Perviz Asaria
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Punam Pabari
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Graham Cole
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Gajen S Kanaganayagam
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Nilesh Sutaria
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Michael Bellamy
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Kevin Fox
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | | | - Ricardo Petraco
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rasha Al-Lamee
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sukhjinder S Nijjer
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sayan Sen
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Neil Ruparelia
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christopher Baker
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Ghada Mikhail
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Iqbal Malik
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Ramzi Khamis
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Amanda Varnava
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Darrel Francis
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jamil Mayet
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Bushra Rana
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
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14
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Seligman H, Sen S, Nijjer S, Al-Lamee R, Clifford P, Sethi A, Hadjiloizou N, Kaprielian R, Ramrakha P, Bellamy M, Khan MA, Kooner J, Foale RA, Mikhail G, Baker CS, Mayet J, Malik I, Khamis R, Francis D, Petraco R. Management of Acute Coronary Syndromes During the Coronavirus Disease 2019 Pandemic: Deviations from Guidelines and Pragmatic Considerations for Patients and Healthcare Workers. ACTA ACUST UNITED AC 2020; 15:e16. [PMID: 33318752 PMCID: PMC7726851 DOI: 10.15420/icr.2020.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is forcing cardiology departments to rapidly adapt existing clinical guidelines to a new reality and this is especially the case for acute coronary syndrome pathways. In this focused review, the authors discuss how COVID-19 is affecting acute cardiology care and propose pragmatic guideline modifications for the diagnosis and management of acute coronary syndrome patients, particularly around the appropriateness of invasive strategies as well as length of hospital stay. The authors also discuss the use of personal protective equipment for healthcare workers in cardiology. Based on shared global experiences and growing peer-reviewed literature, it is possible to put in place modified acute coronary syndrome treatment pathways to offer safe pragmatic decisions to patients and staff.
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Affiliation(s)
- Henry Seligman
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Sayan Sen
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Sukhjinder Nijjer
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Rasha Al-Lamee
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | | | | | | | | | | | | | | | - Jaspal Kooner
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | | | | | | | - Jamil Mayet
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust London, UK
| | - Ramzi Khamis
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Darrel Francis
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
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15
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Kalogeras K, Ruparelia N, Kabir T, Jabbour R, Kalantzis C, Bei E, Katsianos E, Naganuma T, Nakamura S, Sen S, Malik I, Mikhail G, Dalby M, Vavuranakis M, Panoulas V. Real-world comparison of the last generation main balloon-expandable and self-expanding valves in patients undergoing TAVI. Does the type matter? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The balloon expandable Edwards Sapien-S3 and Ultra, and the self-expanding Medtronic Evolut-Pro and Evolut-R 34mm represent the main volume of transcatheter aortic valve implantation (TAVI) procedures conducted worldwide.
Purpose
In the present study, we aim to compare the peri-procedural and one-year clinical outcomes between these last generation devices.
Methods
Consecutive patients from the ATLAS (Athens-Tokyo-London Aortic Stenosis) registry, who had undergone TAVI with either the S3/Ultra or Evolut-Pro/R 34mm device, in four centers were retrospectively studied. In-hospital procedural characteristics and outcomes were recorded and compared. Kaplan-Meier estimated 1-year all-cause mortality was compared between groups.
Results
In total, 692 patients (352pts treated with S3/Ultra and 340pts with Evolut-Pro/R34mm device) were included in the analysis. Baseline demographics (age, coronary artery disease risk factors, logistic Euroscore and aortic valve hemodynamics) were similar between the two groups.
In terms of peri-procedural and short-term outcomes, patients treated with the Evolut-Pro/R34mm device had significantly lower peak (25.4±3.6mmHg for S3/Ultra vs 14.9±0.6mmHg for the self-expanding valves, p=0.002) and mean (10.7±0.3mmHg S3/Ultra vs 7.9±0.4mmHg Evolut PRO/R34, p<0.001) gradients at discharge.
Conversely, the S3 demonstrated significantly lower rates of at least moderate residual aortic regurgitation (AR) post-operatively (0.3% vs 4.8% for S3 and Evolut-Pro/R34mm respectively, p=0.001). Interestingly, the rate of new permanent pacemaker (PPM) required after the implantation in pacemaker-free patients on baseline, was higher for the S3/Ultra cohort compared to the self-expanding valve group (17.6% vs 11.7% respectively, p=0.054), however not reaching statistical significance yet. As expected, the need for balloon post dilatation of the implanted prosthesis was less among the S3/Ultra patients (5.5% vs 26.1%, p=0.001).
One-year Kaplan-Meier estimated survival was similar between the two groups (85.9% for S3 vs. 90% for Evolut-Pro/R34mm, plog-rank=0.071). Hazard ratio for all-cause mortality (Pro/R34 vs. S3/Ultra) after adjustment for gender and previous MI was similar between the groups (HR=0.73; 95% CI 0.47 to 1.14, p=0.165).
Conclusions
Real life comparison of the last generation balloon expandable and self-expanding devices demonstrates similar 1-year all-cause mortality. The S3/Ultra platforms, as compared to the Evolut-Pro/R34mm, demonstrate less paravalvular leak, at the expense of higher transvalvular gradients. Long-term follow-up and future larger trials are required to establish any potential long-term difference in clinical outcomes and prognosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Kalogeras
- Royal Brompton and Harefield NHS trust, Harefield, United Kingdom
| | - N Ruparelia
- Imperial College London, London, United Kingdom
| | - T Kabir
- Royal Brompton and Harefield NHS trust, Harefield, United Kingdom
| | - R Jabbour
- Imperial College London, London, United Kingdom
| | - C Kalantzis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Bei
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Katsianos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | | | | | - S Sen
- Imperial College London, London, United Kingdom
| | - I.S Malik
- Imperial College London, London, United Kingdom
| | - G Mikhail
- Imperial College London, London, United Kingdom
| | - M Dalby
- Royal Brompton and Harefield NHS trust, Harefield, United Kingdom
| | - M Vavuranakis
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Panoulas
- Royal Brompton and Harefield NHS trust, Harefield, United Kingdom
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16
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Nicolas J, Claessen BE, Cao D, Sartori S, Baber U, Power D, Chiarito M, Goel R, Roumeliotis A, Chandiramani R, Chen S, Chandrasekhar J, Tchetche D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer‐Gracia M, Naber C, Sharma S, Morice M, Dangas GD, Chieffo A, Mehran R. Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry. Catheter Cardiovasc Interv 2020; 97:E704-E715. [DOI: 10.1002/ccd.29276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Johny Nicolas
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Bimmer E. Claessen
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Davide Cao
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Samantha Sartori
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Usman Baber
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - David Power
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Mauro Chiarito
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
- Department of Cardiology Istituto Clinico Humanitas Milan Italy
| | - Ridhima Goel
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anastasios Roumeliotis
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Siyan Chen
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Jaya Chandrasekhar
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Didier Tchetche
- Groupe CardioVasculaire Interventional Clinique Pasteur Toulouse France
| | | | - Julinda Mehilli
- Munich University Clinic Ludwig‐Maximilians University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance Munich Germany
| | - Thierry Lefèvre
- Institut Hospitalier Jacques Cartier Ramsay Générale de Santé Massy France
| | | | | | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese Policlinico Le Scotte Siena Italy
| | | | | | | | - Nicolas Dumonteil
- Department of Cardiology Rangueil University Hospital Toulouse France
| | | | | | - Ghada Mikhail
- Imperial College Healthcare NHS Trust Hammersmith Hospital London UK
| | | | - Christoph Naber
- Contilia Heart and Vascular Centre Elisabeth Krankenhaus Essen Germany
| | - Samin Sharma
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - George D. Dangas
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - Roxana Mehran
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
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17
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Cook CM, Howard JP, Ahmad Y, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, de Waard GA, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. How Do Fractional Flow Reserve, Whole-Cycle PdPa, and Instantaneous Wave-Free Ratio Correlate With Exercise Coronary Flow Velocity During Exercise-Induced Angina? Circ Cardiovasc Interv 2020; 13:e008460. [PMID: 32200646 DOI: 10.1161/circinterventions.119.008460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 01/10/2023]
Affiliation(s)
- Christopher M Cook
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Amarjit Sethi
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Gerald J Clesham
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Kare H Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.)
| | - Sukhjinder S Nijjer
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Paul A Kelly
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.)
| | - John R Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Iqbal S Malik
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Raffi Kaprielian
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Ghada Mikhail
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Firas Al-Janabi
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Grigoris V Karamasis
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Reto Gamma
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.)
| | - Guus A de Waard
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom (G.J.C., K.H.T., P.A.K., J.R.D., F.A.-J., G.V.K., S.M., R.G., T.R.K.).,Anglia Ruskin University, United Kingdom (G.J.C., J.R.D., F.A.-J., G.V.K., S.M., T.R.K.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, United Kingdom (C.M.C., J.P.H., Y.A., M.J.S.-S., A.S., S.S.N., I.S.M., R.K., G.M., R.P., T.W., G.A.d.W., R.A.-L., J.M., S.S., D.P.F.).,Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
| | - Justin E Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom (C.M.C., J.P.H., Y.A., S.S.N., I.S.M., G.M., R.P., R.A.-L., J.M., S.S., D.P.F., J.E.D.)
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18
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Kalogeras K, Ruparelia N, Kabir T, Jabbour R, Naganuma T, Vavuranakis M, Nakamura S, Wang B, Sen S, Hadjiloizou N, Malik IS, Mikhail G, Dalby M, Panoulas V. Comparison of the self-expanding Evolut-PRO transcatheter aortic valve to its predecessor Evolut-R in the real world multicenter ATLAS registry. Int J Cardiol 2020; 310:120-125. [PMID: 32139239 DOI: 10.1016/j.ijcard.2020.02.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 08/14/2019] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Evolut PRO self-expanding transcatheter aortic valve has been designed to feature an outer pericardial wrap that aims to reduce paravalvular regurgitation (PVR) rates. Medium-term clinical outcomes, compared to its predecessor Evolut R, in a real-world setting, have not been investigated. The aim of the present study was to compare the two valves with regards to peri-procedural complications, early outcomes and mid-term survival. METHODS Consecutive patients, undergoing TAVI with either the Evolut PRO or Evolut R device, from the multicenter ATLAS registry were retrospectively studied. Outcomes studied included periprocedural complications, PVR at discharge, need for new pacemaker implantation and Kaplan-Meier estimated 1-year all-cause mortality. RESULTS Analysis included 673 patients (498 treated with Evolut R and 175 treated with Evolut PRO). At least moderate PVR was numerically lower amongst patients treated with Evolut PRO (7.4% vs 3.8% for Evolut R and Evolut PRO respectively, p = .108). Rates of new permanent pacemaker (PPM) implantation (21.1% vs. 11.9%, p = .023), and bail-out valve-in-valve (2.4% vs. 0%, p = .049) were significantly lower amongst the Evolut PRO group. No differences were demonstrated regarding bleeding, stroke or acute kidney injury. One-year Kaplan-Meier estimated survival was similar between groups (93% for Evolut R vs. 91.2% for Evolut PRO, plog-rank = 0.806). CONCLUSIONS The Evolut PRO self-expanding valve demonstrates similar mid-term survival rates and numerically, yet not significant, lower incidence of PVR compared to its predecessor. Interestingly this new generation valve is associated with a significantly reduced rate for new PPM implantation. Future studies are required to confirm this finding.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Neil Ruparelia
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK
| | - Richard Jabbour
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Manolis Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece; 3(rd) Department of Cardiology, Sotiria Hospital, National & Kapodistrian University of Athens, Greece
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Brian Wang
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Nearchos Hadjiloizou
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Ghada Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Foundation Trust, London, UK; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
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19
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Ahmad Y, Vendrik J, Eftekhari A, Howard JP, Cook C, Rajkumar C, Malik I, Mikhail G, Ruparelia N, Hadjiloizou N, Nijjer S, Al-Lamee R, Petraco R, Warisawa T, Wijntjens GWM, Koch KT, van de Hoef T, de Waard G, Echavarria-Pinto M, Frame A, Sutaria N, Kanaganayagam G, Ariff B, Anderson J, Chukwuemeka A, Fertleman M, Koul S, Iglesias JF, Francis D, Mayet J, Serruys P, Davies J, Escaned J, van Royen N, Götberg M, Juhl Terkelsen C, Høj Christiansen E, Piek JJ, Baan J, Sen S. Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow. Circ Cardiovasc Interv 2019; 12:e008263. [PMID: 31752515 PMCID: PMC6924937 DOI: 10.1161/circinterventions.119.008263] [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: 01/10/2023]
Abstract
Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jeroen Vendrik
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Ashkan Eftekhari
- Aarhus University Hospital Skejby, Denmark (A.E., C.J.T., E.H.C.)
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sukhjinder Nijjer
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | | | - Karel T Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Tim van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Guus de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | | | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Switzerland (J.F.I.)
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Justin Davies
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Javier Escaned
- Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.)
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | | | | | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Jan Baan
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
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20
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Rajkumar CA, Cook C, Shalhoub J, Chukwuemeka A, Jaffer U, Hadjiloizou N, Sen S, Ruparelia N, Mikhail G, Malik IS. Facilitating right-sided axillary artery access for transcatheter aortic valve replacement using the Edwards Sapien 3 and ultra valves: Technical considerations. Catheter Cardiovasc Interv 2019; 96:E747-E754. [PMID: 31631520 DOI: 10.1002/ccd.28558] [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: 08/13/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 11/08/2022]
Abstract
Trans-Axillary Transcatheter Aortic Valve Replacement (TAVR) has become established as the safest arterial approach when femoral arterial anatomy is unfavorable. Although a left sided axillary approach is generally preferred, patient specific factors may require use of the right axillary artery. In this case series we describe procedural modifications that are required to overcome the challenge of restricted space in the ascending aorta for in situ valve preparation of balloon-expandable valve systems when a right sided trans-Axillary approach is taken. These steps permit implantation of both the Edwards LifeSciences Sapien 3 and Ultra prostheses via the right trans-Axillary approach, allowing patients a greater range of valve options when this arterial route is required for TAVR.
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Affiliation(s)
- Christopher A Rajkumar
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.,National Heart and Lung institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Christopher Cook
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.,National Heart and Lung institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Joseph Shalhoub
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Usman Jaffer
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.,National Heart and Lung institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Ghada Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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21
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Kalogeras K, Jabbour RJ, Ruparelia N, Watson S, Kabir T, Naganuma T, Vavuranakis M, Nakamura S, Malik IS, Mikhail G, Dalby M, Panoulas V. Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry. J Thromb Thrombolysis 2019; 50:82-89. [DOI: 10.1007/s11239-019-01968-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Cook CM, Ahmad Y, Howard JP, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, de Waard GA, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. Association Between Physiological Stenosis Severity and Angina-Limited Exercise Time in Patients With Stable Coronary Artery Disease. JAMA Cardiol 2019; 4:569-574. [PMID: 31042268 PMCID: PMC6495364 DOI: 10.1001/jamacardio.2019.1139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/10/2023]
Abstract
Importance Physiological stenosis assessment is recommended to guide percutaneous coronary intervention (PCI) in patients with stable angina. Objective To determine the association between all commonly used indices of physiological stenosis severity and angina-limited exercise time in patients with stable angina. Design, Setting, and Participants This cohort study included data (without follow-up) collected over 1 year from 2 cardiac hospitals. Selected patients with stable angina and physiologically severe single-vessel coronary artery disease presenting for clinically driven elective PCI were included. Exposures Fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), hyperemic stenosis resistance (HSR), and coronary flow reserve (CFR) were measured invasively. Immediately after this, patients maximally exercised on a catheter-table-mounted supine ergometer until they developed rate-limiting angina. Subsequent PCI was performed in most patients, followed by repeat maximal supine exercise testing. Main Outcomes and Measures Associations between FFR, iFR, HSR, CFR, and angina-limited exercise time were assessed using linear regression and Pearson correlation coefficients. Additionally, the associations between the post-PCI increment in exercise time and baseline FFR, iFR, HSR, and CFR were assessed. Results Twenty-three patients (21 [91.3%] of whom were male; mean [SD] age, 60.6 [8.1] years) completed the pre-PCI component of the study protocol. Mean (SD) stenosis diameter was 74.6% (10.4%). Median (interquartile range [IQR]) values were 0.54 (0.44-0.72) for FFR, 0.53 (0.38-0.83) for iFR, 1.67 (0.84-3.16) for HSR, and 1.35 (1.11-1.63) for CFR. Mean (SD) angina-limited exercise time was 144 (77) seconds. Anatomical stenosis characteristics were not significantly associated with angina-limited exercise time. Conversely, FFR (R2 = 0.27; P = .01), iFR (R2 = 0.46; P < .001), HSR (R2 = 0.39; P < .01), and CFR (R2 = 0.16; P < .05) were all associated with angina-limited exercise time. Twenty-one patients (19 [90.5%] of whom were male; mean [SD] age, 60.1 [8.2] years) competed the full protocol of PCI, post-PCI physiological assessment, and post-PCI maximal exercise. After PCI, the median (IQR) FFR rose to 0.91 (0.85-0.96), median (IQR) iFR to 0.98 (0.94-0.99), and median (IQR) CFR to 2.73 (2.50-3.12), while the median (IQR) HSR fell to 0.16 (0.06-0.37) (P < .001 for all). The post-PCI increment in exercise time was most significantly associated with baseline iFR (R2 = 0.26; P = .02). Conclusions and Relevance In a selected group of patients with severe, single-vessel stable angina, FFR, iFR, HSR, and CFR were all modestly correlated with angina-limited exercise time to varying degrees. Notwithstanding the limited sample size, no clear association was demonstrated between anatomical stenosis severity and angina-limited exercise time.
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Affiliation(s)
| | | | | | | | | | - Gerald J. Clesham
- Essex Cardiothoracic Centre, Basildon, United Kingdom,Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Kare H. Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | | | - Paul A. Kelly
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - John R. Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom,Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | | | | | | | | | | | - Firas Al-Janabi
- Essex Cardiothoracic Centre, Basildon, United Kingdom,Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Grigoris V. Karamasis
- Essex Cardiothoracic Centre, Basildon, United Kingdom,Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon, United Kingdom,Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Reto Gamma
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | | | | | - Thomas R. Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom,Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Jamil Mayet
- Imperial College London, London, United Kingdom
| | - Sayan Sen
- Imperial College London, London, United Kingdom
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23
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Guedeney P, Tchétché D, Petronio AS, Mehilli J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Sorrentino S, Claessen BEPM, Chandrasekhar J, Vogel B, Kalkman DN, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer-Grazia MC, Naber C, Kievit P, Baber U, Sharma S, Morice MC, Chieffo A, Mehran R. Impact of coronary artery disease and percutaneous coronary intervention in women undergoing transcatheter aortic valve replacement: From the WIN-TAVI registry. Catheter Cardiovasc Interv 2018; 93:1124-1131. [PMID: 30511802 DOI: 10.1002/ccd.28012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the impact of coronary artery disease (CAD) with or without recent (≤ 30 days) percutaneous coronary intervention (PCI) in women undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Although women display a specific risk-profile for both PCI and TAVR, the impact of CAD and PCI in the setting of TAVR in women is unclear. METHODS The multinational Women's International Transcatheter Aortic Valve implantation registry enrolled consecutive female patients undergoing contemporary TAVR in 19 centers between 2013 and 2015. Patients with available coronary angiography or CT scan in the pre-operative assessment of TAVR were categorized as without CAD, with CAD but no recent PCI and CAD and recent PCI (≤30 days). All events were adjudicated according to the VARC-2 criteria. RESULTS A total of 787 patients were included in this analysis, among whom 459 (58.3%) had no CAD, 247 (31.4%) had CAD without recent PCI and 81 (10.3%) underwent recent PCI (≤ 30 days before TAVR). After multivariable adjustment, both groups of CAD patients, without and with recent PCI, presented with higher risk of death, myocardial infarction or stroke, compared with patients without CAD (adj HR 1.56, 95%CI 1.03-2.39, P = 0.038 and adj HR 1.96, 95% CI 1.1-3.5, P = .021, respectively). Patients with recent PCI had increased risk of all-cause death (adj HR 1.89, 95% CI 1.0-3.5, P = 0.04) and stroke (adj HR 3.7, 95% CI 1.0-13.5, P = 0.046) compared with patients without CAD. CONCLUSION The presence of CAD in women undergoing TAVR, with or without recent PCI, was associated with long-term poorer outcomes.
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Affiliation(s)
- Paul Guedeney
- Icahn School of Medicine at Mount Sinai, New York, New York.,Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Didier Tchétché
- Groupe CardioVasculaire Interventional, Clinique Pasteur, Toulouse, France
| | | | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians-University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | | | - Thierry Lefèvre
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | | | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Gennaro Sardella
- Policlinico "Umberto I", "Sapienza" University of Rome, Rome, Italy
| | | | | | | | | | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Nicolas Dumonteil
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Chiara Fraccaro
- Department of Cardiology, University of Padova, Padova, Italy
| | | | - Ghada Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany
| | - Peter Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin Sharma
- Department of Cardiology, Mount Sinai Hospital, New York, New York
| | - Marie-Claude Morice
- Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Guedeney P, Chieffo A, Snyder C, Mehilli J, Petronio AS, Claessen BE, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchétché D, Iadanza A, Sardella G, Van Mieghem NM, Chandrasekhar J, Vogel B, Sorrentino S, Kalkman DN, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer MC, Naber C, Kievit P, Baber U, Sharma S, Morice MC, Mehran R. Impact of Baseline Atrial Fibrillation on Outcomes Among Women Who Underwent Contemporary Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry). Am J Cardiol 2018; 122:1909-1916. [PMID: 30318417 DOI: 10.1016/j.amjcard.2018.08.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
Pre-existing atrial fibrillation (AF) is common among patients who underwent transcatheter aortic valve implantation (TAVI) and has been associated with adverse outcomes. The specific impact of AF at baseline in women who underwent TAVI, however, remains unknown. The Women's International Transcatheter Aortic Valve Implantation is a prospective, multinational registry evaluating the safety and performance of contemporary TAVI in women in 19 centers between January 2013 and December 2015. Patients with available electrocardiogram at baseline were compared according to the presence of AF. All events were adjudicated according to the Valve Academic Research Consortium 2 criteria. Associations between AF and outcomes were tested using multivariate Cox regression model. Of the 993 women with available baseline electrocardiogram included in the study, 200 (20.1%) presented with AF. Patients with AF at baseline had higher Euroscore I score values and more frequently had chronic kidney disease or prior stroke. Patients without AF more frequently had coronary artery disease. There was no difference regarding in-hospital events between the two groups aside from longer length of stay for patients with AF (13.3 ± 11 vs 11.5 ± 7.1 days, p = 0.01). In multivariate analysis, AF at baseline was associated with an increase of all-cause and cardiovascular death at 12 months (adjHR 1.67 95%CI 1.11 to 2.50, p = 0.013 and adjHR 1.85 95%CI 1.19 to 2.86, p = 0.006 respectively). In conclusion, in this prospective registry of women who underwent contemporary TAVI, the presence of AF at baseline was associated with significantly increased 12-month mortality.
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25
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Ahmad Y, Götberg M, Cook C, Howard JP, Malik I, Mikhail G, Frame A, Petraco R, Rajkumar C, Demir O, Iglesias JF, Bhindi R, Koul S, Hadjiloizou N, Gerber R, Ramrakha P, Ruparelia N, Sutaria N, Kanaganayagam G, Ariff B, Fertleman M, Anderson J, Chukwuemeka A, Francis D, Mayet J, Serruys P, Davies J, Sen S. Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement: Implications for Clinical Indices of Coronary Stenosis Severity. JACC Cardiovasc Interv 2018; 11:2019-2031. [PMID: 30154062 PMCID: PMC6197079 DOI: 10.1016/j.jcin.2018.07.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects: 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve. BACKGROUND A significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied. METHODS Twenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR. RESULTS Flow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s; p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR; p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR; p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR; p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR; p = 0.001). CONCLUSIONS Systolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free period of diastole did not change post-TAVR, suggesting that indices calculated during this period are not vulnerable to the confounding effect of the stenotic aortic valve.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Ozan Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert Gerber
- Department of Cardiology, Conquest Hospital, St. Leonards-on-Sea, United Kingdom
| | - Punit Ramrakha
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Justin Davies
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom.
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Cook C, Ahmad Y, Howard J, Shun-Shin M, Sethi A, Clesham G, Tang K, Nijjer S, Kelly P, Davies J, Malik I, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis G, Gamma R, Al-Lamee R, Keeble T, Mayet J, Sen S, Francis D, Davies J. TCT-96 Predicting angina-limited exercise capacity using coronary physiology. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1193] [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: 01/09/2023]
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27
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Ahmad Y, Gotberg M, Cook C, Howard J, Malik I, Mikhail G, Francis D, Mayet J, Davies J, Sen S. TCT-9 Coronary pressure and flow in patients with severe aortic stenosis and coronary artery disease undergoing TAVI: implications for clinical indices of coronary stenosis severity. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Cook CM, Ahmad Y, Howard JP, Shun-Shin MJ, Sethi A, Clesham GJ, Tang KH, Nijjer SS, Kelly PA, Davies JR, Malik IS, Kaprielian R, Mikhail G, Petraco R, Al-Janabi F, Karamasis GV, Mohdnazri S, Gamma R, Al-Lamee R, Keeble TR, Mayet J, Sen S, Francis DP, Davies JE. Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease. J Am Coll Cardiol 2018; 72:970-983. [PMID: 30139442 PMCID: PMC6580361 DOI: 10.1016/j.jacc.2018.06.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 06/09/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). OBJECTIVES The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD. METHODS A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles. RESULTS PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001). CONCLUSIONS In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.
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Affiliation(s)
| | | | | | | | | | - Gerald J Clesham
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Kare H Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | | | - Paul A Kelly
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - John R Davies
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | | | | | | | | | - Firas Al-Janabi
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Grigoris V Karamasis
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Shah Mohdnazri
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Reto Gamma
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | | | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom; Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Jamil Mayet
- Imperial College London, London, United Kingdom
| | - Sayan Sen
- Imperial College London, London, United Kingdom
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Ahmad Y, Demir O, Rajkumar C, Howard JP, Shun-Shin M, Cook C, Petraco R, Jabbour R, Arnold A, Frame A, Sutaria N, Ariff B, Kanaganayagam G, Francis D, Mayet J, Mikhail G, Malik I, Sen S. Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis. Open Heart 2018; 5:e000748. [PMID: 29387433 PMCID: PMC5786926 DOI: 10.1136/openhrt-2017-000748] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/13/2017] [Accepted: 12/29/2017] [Indexed: 01/09/2023] Open
Abstract
Objective International guidelines recommend the use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The recommended duration of DAPT varies between guidelines. In this two-part study, we (1) performed a structured survey of 45 TAVI centres from around the world to determine if there is consensus among clinicians regarding antiplatelet therapy after TAVI; and then (2) performed a systematic review of all suitable studies (randomised controlled trials (RCTs) and registries) to determine if aspirin monotherapy can be used instead of DAPT. Methods A structured electronic survey regarding antiplatelet use after TAVI was completed by 45 TAVI centres across Europe, Australasia and the USA. A systematic review of TAVI RCTs and registries was then performed comparing DAPT duration and incidence of stroke, bleeding and death. A variance weighted least squared metaregression was then performed to determine the relationship of antiplatelet therapy and adverse events. Results 82.2% of centres routinely used DAPT after TAVI. Median duration was 3 months. 13.3% based their practice on guidelines. 11 781 patients (26 studies) were eligible for the metaregression. There was no benefit of DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or bleeding (P=0.91). Discussion Aspirin monotherapy appears to be as safe and effective as DAPT after TAVI.
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Affiliation(s)
- Yousif Ahmad
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ozan Demir
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Christopher Rajkumar
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - James P Howard
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Matthew Shun-Shin
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Christopher Cook
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ricardo Petraco
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Richard Jabbour
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ahran Arnold
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Angela Frame
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Nilesh Sutaria
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ben Ariff
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Gajen Kanaganayagam
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Darrel Francis
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Jamil Mayet
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ghada Mikhail
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Iqbal Malik
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Sayan Sen
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
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Rolls AE, Riga CV, Rahim S, Stoyanov DV, Van Herzeele I, Mikhail G, Hamady M, Cheshire NJ, Bicknell CD. Video motion analysis in live coronary angiography differentiates levels of experience and provides a novel method of skill assessment. EUROINTERVENTION 2017. [PMID: 28649951 DOI: 10.4244/eij-d-17-00150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/23/2022]
Abstract
AIMS Video motion analysis (VMA) uses fluoroscopic sequences to derive catheter and guidewire movement, and is able to calculate 2D catheter-tip path length (PL) on the basis of frame-by-frame pixel coordinates. The objective of this study was to validate VMA in coronary angiography as a method of skill assessment. METHODS AND RESULTS Forty-seven coronary interventions performed by 10 low- (<1,000 cases; group A), five medium- (1,000-4,000; group B) and six high- (>4,000; group C) experience-volume cardiologists were prospectively recorded and analysed using VMA software. Total PL was calculated and procedure, fluoroscopy times, and radiation dose were recorded. Comparisons of PL were made between groups of experience. Groups A, B and C performed 24, 14 and 6 paired (right and left coronary) cannulations, respectively. Calculation of PL was possible in all recorded cases and significantly correlated with procedure (p=<0.001, rho=0.827) and fluoroscopy times (p=<0.001, rho=0.888). Median total path length (combined right and left coronaries) was significantly shorter in group C which used 3,836 pixels of movement (IQR: 3,003-4,484) vs. 10,556 (7,242-31,408) in group A (p=<0.001) and 8,725 (5,187-15,150) in group B (p=0.013). CONCLUSIONS VMA in coronary angiography is feasible and PL is able to differentiate levels of experience.
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Affiliation(s)
- Alexander E Rolls
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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31
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Ahmad Y, Demir O, Howard J, Shun-Shin M, Cook C, Petraco R, Al-Lamee R, Jabbour R, Sutaria N, Ariff B, Kanaganayagam G, Chukwuemeka A, Anderson J, Francis D, Mayet J, Davies J, Mikhail G, Malik I, Sen S. TCT-120 Aspirin is equivalent to dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of 11,781 patients. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.178] [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: 01/09/2023]
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Mehilli J, Chieffo A, Petronio AS, Chandrasekhar J, Sartori S, Lefevre T, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem N, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Sharma S, Ferrer Gracia MC, Kievit P, Baber U, Snyder C, Sharma M, Morice MC, Mehran R. TCT-117 Impact of Discharge Location After Transcatheter Aortic Valve Replacement On 1-Year Outcomes In Women: Results From The WIN-TAVI Registry. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mehilli J, Chieffo A, Petronio A, Lefevre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Mikhail G, Sartori S, Snyder C, Chandrasekhar J, Morice M, Mehran R. P3283Predictors of pacemaker implantation in women undergoing contemporary transcatheter aortic valve replacement: Results from the WIN-TAVI registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Mehilli
- Ludwig-Maximilians University, Munich, Germany
| | - A. Chieffo
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | | | - T. Lefevre
- Institut Hospitalier Jacques Cartier, Massy, France
| | - P. Presbitero
- UOS of Milan and Humanitas Clinical and Research Center, Milan, Italy
| | | | - D. Tchetche
- Clinic Pasteur of Toulouse, Toulouse, France
| | - A. Iadanza
- Polyclinic Santa Maria alle Scotte, Siena, Italy
| | | | - G. Mikhail
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S. Sartori
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | - C. Snyder
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | - J. Chandrasekhar
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
| | - M. Morice
- Institut Hospitalier Jacques Cartier, Massy, France
| | - R. Mehran
- Mount Sinai School of Medicine, Cardiology, New York, United States of America
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Hengstenberg C, Chandrasekhar J, Sartori S, Lefevre T, Mikhail G, Meneveau N, Tron C, Jeger R, Kupatt C, Vogel B, Farhan S, Sorrentino S, Sharma M, Snyder C, Husser O, Boekstegers P, Hambrecht R, Widder J, Hildick-Smith D, De Carlo M, Wijngaard P, Deliargyris E, Bernstein D, Baber U, Mehran R, Anthopoulos P, Dangas G. Impact of pre-existing or new-onset atrial fibrillation on 30-day clinical outcomes following transcatheter aortic valve replacement: Results from the BRAVO 3 randomized trial. Catheter Cardiovasc Interv 2017; 90:1027-1037. [DOI: 10.1002/ccd.27155] [Citation(s) in RCA: 7] [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: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance; Munich Germany
- Division of Cardiology, Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | - Jaya Chandrasekhar
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Samantha Sartori
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Thierry Lefevre
- Division of Cardiology; Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé; Massy France
| | - Ghada Mikhail
- Division of Cardiology; Imperial College Healthcare NHS Trust, Hammersmith Hospital; London United Kingdom
| | | | | | - Raban Jeger
- Department of Cardiology; University Hospital Basel; Switzerland
| | | | - Birgit Vogel
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Serdar Farhan
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Sabato Sorrentino
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Madhav Sharma
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Clayton Snyder
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Oliver Husser
- Division of Cardiology; Deutsches Herzzentrum München; Germany
| | | | - Rainer Hambrecht
- Department of Cardiology and Angiology; Klinikum Links der Weser; Bremen Germany
| | - Julian Widder
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | - David Hildick-Smith
- Division of Cardiology; Sussex Cardiac Centre-Brighton & Sussex University Hospitals NHS Trust; Brighton East Sussex United Kingdom
| | - Marco De Carlo
- Division of Cardiology; Azienda Ospedaliero-Universitaria Pisana; Pisa Italy
| | - Peter Wijngaard
- Division of Cardiology; The Medicines Company; Zurich Switzerland
| | | | - Debra Bernstein
- Division of Cardiology; The Medicines Company; Parsippany New Jersey
| | - Usman Baber
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | - Roxana Mehran
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
| | | | - George Dangas
- Division of Cardiology; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; New York
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Chandrasekhar J, Mehran R, Hengstenberg C, Vogel B, Asgar A, Berg JT, Mikhail G, Meneveau N, Widder J, Violini R, Hildick-Smith D, Boekstegers P, Eric VB, Husser O, Hink HU, Wijngaard P, Grube E, Baber U, Deliargyris E, Anthopoulos P, Dangas G. INCIDENCE OF ACUTE KIDNEY INJURY WITH BIVALIRUDIN OR UNFRACTIONATED HEPARIN FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT: RESULTS FROM THE BRAVO-3 RANDOMIZED TRIAL. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Chandrasekhar J, Chieffo A, Petronio A, Sartori S, Mehilli J, Lefevre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Mieghem NV, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Sharma S, Ferrer M, Naber C, Kievit P, Faggioni M, Baber U, Morice M, Mehran R. IMPACT OF SINGLE VERSUS DUAL ANTI PLATELET THERAPY ON EARLY OUTCOMES IN WOMEN UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: FROM THE WIN-TAVI REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34594-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Chieffo A, Petronio AS, Mehilli J, Chandrasekhar J, Sartori S, Lefevre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem N, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Sharma S, Ferrer M, Naber C, Kievit P, Faggioni M, Morice MC, Mehran R. TCT-718 Predictors of vascular complications in women undergoing contemporary transcatheter aortic valve replacement: A report from the WIN-TAVI registry. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Asgar A, Chandrasekhar J, Mikhail G, Webb J, Lefèvre T, Tamburino C, Hildick-Smith D, Hambrecht R, Van Belle E, Widder J, Dumonteil N, Hink U, Jeger R, Linke A, Deliargyris E, Gao P, Mehran R, Hengstenberg C, Anthopoulos P, Dangas G. Sex-based differences in outcomes with bivalirudin or unfractionated heparin for transcatheter aortic valve replacement: Results from the BRAVO-3 randomized trial. Catheter Cardiovasc Interv 2016; 89:144-153. [DOI: 10.1002/ccd.26607] [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: 04/26/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 12/19/2022]
Affiliation(s)
- A. Asgar
- Division of Cardiology; Montreal Heart Institute; Montreal Canada
| | - J. Chandrasekhar
- Icahn School of Medicine at Mount Sinai; The Zena and Michael a. Wiener Cardiovascular Institute; New York New York
| | - G. Mikhail
- Imperial College Healthcare NHS Trust, Hammersmith Hospital; London United Kingdom
| | - J. Webb
- Division of Cardiology; St. Paul's Hospital; Vancouver British Columbia Canada
| | - T. Lefèvre
- Ramsay Générale De Santé; Institut Hospitalier Jacques Cartier; Massy France
| | - C. Tamburino
- Department of Cardiology; University of Catania; Catania Italy
| | - D. Hildick-Smith
- Sussex Cardiac Centre-Brighton & Sussex University Hospitals NHS Trust; Brighton East Sussex, United Kingdom
| | - R. Hambrecht
- Department of Cardiology and Angiology; Klinikum Links Der Weser; Bremen Germany
| | - E. Van Belle
- Centre Hospitalier Universitaire De Lille; Lille France
| | - J. Widder
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | - N. Dumonteil
- Department of Cardiology; Rangueil University Hospital; Toulouse France
| | - U Hink
- Cardiology Department; Johannes Gutenberg University Hospital; Mainz Germany
| | - R. Jeger
- Department of Cardiology; University Hospital Basel; Basel Switzerland
| | - A. Linke
- Department of Internal Medicine/Cardiology; University of Leipzig, Heart Centre; Germany
| | | | - P. Gao
- The Medicines Company; Parsippany New Jersey
| | - R. Mehran
- Icahn School of Medicine at Mount Sinai; The Zena and Michael a. Wiener Cardiovascular Institute; New York New York
| | - C. Hengstenberg
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany, and Deutsches Herzzentrum München; Technische Universität München; Munich Germany
| | | | - G. Dangas
- Icahn School of Medicine at Mount Sinai; The Zena and Michael a. Wiener Cardiovascular Institute; New York New York
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Ahmad Y, Cook C, Petraco R, Nijjer S, Al-Lamee R, Shun-Shin M, Keene D, Balu A, Malik I, Baker C, Mikhail G, Sethi A, Foale R, Davies J, Mayet J, Francis D, Sen S. 97 Multi-vessel Angioplasty at the Time of STEMI has Equivalent Mortality to a Culprit Only Strategy: Resolving The Paradox of Randomised Controlled Trials and Observational Studies in Multivessel Disease and STEMI. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ahmad Y, Sen S, Nijjer S, Keene D, Cook C, Petraco R, Shun-Shin M, Cole G, Al-Lamee R, Malik I, Baker C, Mikhail G, Foale R, Mayet J, Davies J, Francis D. 35 Thrombus Aspiration does not Reduce Mortality in STEMI Patients: A Meta-Analysis of 20,192 Patients, with Implications for Future Trial Design. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Giustino G, Salianski O, Baber U, Sartori S, Aquino M, Stefanini GG, Leon M, Stone GW, Morice MC, Smits PC, von Birgelen C, Mikhail G, Kastrati A, Chieffo A, Mehran R. TCT-577 Early- Versus New-Generation Drug-Eluting Stents in Women at High Risk for Atherothrombosis: Results froma Patient-Level Pooled Analysis of Randomized Controlled Trials. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ahmad Y, Sen S, Keene D, Cook C, Nijjer SS, Petraco R, Finegold J, Shun-Shin M, Cole G, Malik IS, Baker CS, Bellamy M, Kaprielian RR, Mikhail G, Davies JE, Mayet J, Francis DP. TCT-262 Thrombus aspiration does not reduce mortality in STEMI patients: a meta-analysis of 20,192 patients, with implications for future trial design. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.945] [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: 01/09/2023]
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Giustino G, Baber U, Stefanini GG, Aquino M, Stone GW, Sartori S, Steg PG, Wijns W, Smits PC, Jeger RV, Leon MB, Windecker S, Serruys PW, Morice MC, Camenzind E, Weisz G, Kandzari D, Dangas GD, Mastoris I, Von Birgelen C, Galatius S, Kimura T, Mikhail G, Itchhaporia D, Mehta L, Ortega R, Kim HS, Valgimigli M, Kastrati A, Chieffo A, Mehran R. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents. Am J Cardiol 2015; 116:845-52. [PMID: 26174605 DOI: 10.1016/j.amjcard.2015.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women.
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Iqbal MB, Khamis R, Ilsley C, Mikhail G, Crake T, Firoozi S, Kalra S, Knight C, Archbold A, Lim P, Mathur A, Meier P, Rakhit RD, Redwood S, Whitbread M, Bromage D, Rathod K, Jones DA, Wragg A, Dalby M, MacCarthy P, Malik IS. Time-trend analyses of bleeding and mortality after primary percutaneous coronary intervention during out of working hours versus in-working hours: an observational study of 11 466 patients. Circ Cardiovasc Interv 2015; 8:e002206. [PMID: 26038482 DOI: 10.1161/circinterventions.114.002206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment-elevation myocardial infarction. Resources are limited during out of working hours (OWH). Whether PPCI outside working hours is associated with worse outcomes and whether outcomes have improved over time are unknown. METHODS AND RESULTS We analyzed 11 466 patients undergoing PPCI between 2004 and 2011 at all 8 tertiary cardiac centers in London, United Kingdom. We defined working hours as 9 am to 5 pm (Monday to Friday). We analyzed in-hospital bleeding and all-cause mortality ≤3 years, comparing OWH versus in-working hours. A total of 7494 patients (65.3%) were treated during OWH. Multivariable analyses demonstrated that PPCI during OWH was not a predictor for bleeding (odds ratio, 1.47; 95% confidence interval [CI], 0.97-2.24; P=0.071) or 3-year mortality (hazard ratio, 1.11; 95% CI, 0.94-1.32; P=0.20). This was confirmed in propensity-matched analyses. Time-stratified analyses demonstrated that PPCI during OWH was a predictor for bleeding (odds ratio, 2.00; 95% CI, 1.06-3.80; P=0.034) and 3-year mortality during 2005 to 2008 (hazard ratio, 1.23; 95% CI, 1.00-1.50; P=0.050), but this association was lost during 2009 to 2011. During 2005 to 2008, transradial access was predominantly used during in-working hours and PPCI during OWH was predictive of reduced transradial access use (odds ratio, 0.83; 95% CI, 0.71-0.98; P=0.033), but this association was lost during 2009 to 2011. CONCLUSIONS In this study of unselected patients with ST-segment-elevation myocardial infarction, PPCI during OWH versus in-working hours had comparable bleeding and mortality. Time-stratified analyses demonstrated a reduction in adjusted bleeding and mortality during OWH over time. This may reflect the improved service provision, but the increased adoption of transradial access during OWH may also be contributory.
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Affiliation(s)
- M Bilal Iqbal
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.).
| | - Ramzi Khamis
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Ilsley
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Ghada Mikhail
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Tom Crake
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sam Firoozi
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sundeep Kalra
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Knight
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Andrew Archbold
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pitt Lim
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Anthony Mathur
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pascal Meier
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Roby D Rakhit
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Simon Redwood
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Mark Whitbread
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Dan Bromage
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Krishna Rathod
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Daniel A Jones
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Andrew Wragg
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Miles Dalby
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Phil MacCarthy
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Iqbal S Malik
- From the Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., M.D.); Department of Cardiology, Victoria Heart Institute Foundation, Victoria, British Columbia, Canada (M.B.I.); Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom (R.K., G.M., I.S.M.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Kings College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, Bonner Road, London, United Kingdom (C.K., A.A., A.M., D.B., K.R., D.A.J., A.W.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, Kings College London, St. Thomas' Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
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Nijjer S, Sen S, Petraco R, Al-Lamee R, Broyd C, Mayet J, Francis D, Davies J, Mikhail G, Malik I. 105 Virtual PCI with iFR-Pullback in Complex Coronary Disease: The Potential for Reducing Stent Length. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Nijjer S, Sen S, Davies J, Petraco R, Al-Lamee R, Broyd C, Mikhail G, Malik I, Mayet J, Francis D. 106 Virtual-PCI With iFR-Pullback can Plan Coronary Intervention in Complex Coronary Disease with a Prediction of Functional Gain. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Costopoulos C, Frame A, Mikhail G, Sutaria N, Ariff B, Anderson J, Chukwuemeka A, Malik IS. TCT-747 Cost of transcatheter aortic valve implantation in the real-world: a single-center experience. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nijjer SS, Sen S, Petraco R, Escaned J, Echavarria-Pinto M, Al-Lamee R, Foin N, Malik IS, Mikhail G, Sethi A, Khan MA, Baker CS, Bellamy M, Francis DP, Di Mario C, Davies JE. TCT-311 Pressure Wire Pullback Using the Instantaneous Wave-Free Ratio (iFR) Can Identify Stenoses and Predict the Improvement After Stenting. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Iqbal MB, Ilsley CD, Mikhail G, Khamis R, Archbold A, Crake T, Firoozi S, Kalra SS, Knight C, Lim P, Mathur A, Meier P, Rakhit R, Redwood S, Whitbread M, Bromage D, Rathod K, Wragg A, MacCarthy PA, Dalby MC, Malik IS. TCT-28 Comparison Of Outcomes For Primary Percutaneous Coronary Intervention During Out Of Working Hours Versus In Working Hours: An Observational Cohort Study Of 11,461 Patients. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nijjer SS, van de Hoef T, da Cunha RP, Sen S, Meuwissen M, Foale RA, Van Lavieren M, Echavarria-Pinto M, Malik I, Mikhail G, Hughes A, Francis D, Mayet J, Escaned J, Di Mario C, Piek J, Davies J. RESTING CORONARY BLOOD FLOW VELOCITY IS CONSTANT ACROSS ALL STENOSIS SEVERITIES: IMPLICATIONS FOR TANDEM LESION AND PULLBACK ASSESSMENT. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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