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Kite TA, Chase A, Owens CG, Shaukat A, Mozid AM, O'Kane P, Routledge H, Perera D, Jain AK, Palmer N, Hoole SP, Egred M, Sinha MK, Cahill TJ, Anantharam B, Byrne J, Morris PD, Kean S, Sabra A, Aetesam-Ur-Rahman M, Mailey J, Demir O, Mouyis K, Abdalwahab A, Terentes-Printzios D, Kanyal R, Curzen N, Berry C, Gershlick AH, Ladwiniec A. Complex percutaneous coronary intervention in patients unable to undergo coronary artery bypass grafting during the COVID-19 pandemic: insights from the UK-ReVasc Registry. J Invasive Cardiol 2024. [PMID: 38471155 DOI: 10.25270/jic/24.00030] [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] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVES Cardiac surgery for coronary artery disease was dramatically reduced during the first wave of the COVID-19 pandemic. Many patients with disease ordinarily treated with coronary artery bypass grafting (CABG) instead underwent percutaneous coronary intervention (PCI). We sought to describe 12-month outcomes following PCI in patients who would typically have undergone CABG. METHODS Between March 1 and July 31, 2020, patients who received revascularization with PCI when CABG would have been the primary choice of revascularization were enrolled in the prospective, multicenter UK-ReVasc Registry. We evaluated the following major adverse cardiovascular events at 12 months: all-cause mortality, myocardial infarction, repeat revascularization, stroke, major bleeding, and stent thrombosis. RESULTS A total of 215 patients were enrolled across 45 PCI centers in the United Kingdom. Twelve-month follow up data were obtained for 97% of the cases. There were 9 deaths (4.3%), 5 myocardial infarctions (2.4%), 12 repeat revascularizations (5.7%), 1 stroke (0.5%), 3 major bleeds (1.4%), and no cases of stent thrombosis. No difference in the primary endpoint was observed between patients who received complete vs incomplete revascularization (residual SYNTAX score £ 8 vs > 8) (P = .22). CONCLUSIONS In patients with patterns of coronary disease in whom CABG would have been the primary therapeutic choice outside of the pandemic, PCI was associated with acceptable outcomes at 12 months of follow-up. Contemporary randomized trials that compare PCI to CABG in such patient cohorts may be warranted.
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Affiliation(s)
- Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Center, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Alexander Chase
- College of Medicine, Swansea University, Morriston Regional Heart Center, Swansea, UK
| | - Colum G Owens
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Peter O'Kane
- Dorset Heart Center, Royal Bournemouth Hospital, Bournemouth, UK
| | | | - Divaka Perera
- BHF Center of Research Excellence and NIHR Biomedical Research Center at King's College London, UK
| | - Ajay K Jain
- Barts Heart Center St Bartholomew's Hospital, Barts and the London School of Medicine and Dentistry, London, UK
| | - Nick Palmer
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Mohaned Egred
- Freeman Hospital, Newcastle University, Translational and Clinical Research Institute, Newcastle-Upon-Tyne, UK
| | | | - Thomas J Cahill
- Oxford Heart Center, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jonathan Byrne
- Department of Cardiology, King's College NHS Foundation Trust, London, UK
| | - Paul D Morris
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - Sharon Kean
- Robertson Center for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ahmed Sabra
- College of Medicine, Swansea University, Morriston Regional Heart Center, Swansea, UK
| | - Muhammad Aetesam-Ur-Rahman
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Center, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Ozan Demir
- BHF Center of Research Excellence and NIHR Biomedical Research Center at King's College London, UK; Guy's and St Thomas' Hospital NHS Foundation Trust, UK
| | - Kyriacos Mouyis
- Barts Heart Center St Bartholomew's Hospital, Barts and the London School of Medicine and Dentistry, London, UK
| | - Ahmed Abdalwahab
- Freeman Hospital, Newcastle University, Translational and Clinical Research Institute, Newcastle-Upon-Tyne, UK
| | | | - Ritesh Kanyal
- Department of Cardiology, King's College NHS Foundation Trust, London, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Center, University of Glasgow, UK; Golden Jubilee National Hospital, Clydebank, UK
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Center, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew Ladwiniec
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Center, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
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Ali N, Hildick-Smith D, Parker J, Malkin CJ, Cunnington MS, Gurung S, Mailey J, MacCarthy PA, Bharucha A, Brecker SJ, Hoole SP, Dorman S, Doshi SN, Wiper A, Buch MH, Banning AP, Spence MS, Blackman DJ. Long-term durability of self-expanding and balloon-expandable transcatheter aortic valve prostheses: UK TAVI registry. Catheter Cardiovasc Interv 2023; 101:932-942. [PMID: 36924015 DOI: 10.1002/ccd.30627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND With expansion of transcatheter aortic valve implantation (TAVI) into younger patients, valve durability is critically important. AIMS We aimed to evaluate long-term valve function and incidence of severe structural valve deterioration (SVD) among patients ≥ 10-years post-TAVI and with echocardiographic follow-up at least 5-years postprocedure. METHODS Data on patients who underwent TAVI from 2007 to 2011 were obtained from the UK TAVI registry. Patients with paired echocardiograms postprocedure and ≥5-years post-TAVI were included. Severe SVD was determined according to European task force guidelines. RESULTS 221 patients (79.4 ± 7.3 years; 53% male) were included with median echocardiographic follow-up 7.0 years (range 5-13 years). Follow-up exceeded 10 years in 43 patients (19.5%). Valve types were the supra-annular self-expanding CoreValve (SEV; n = 143, 67%), balloon-expandable SAPIEN/XT (BEV; n = 67, 31%), Portico (n = 4, 5%) and unknown (n = 7, 3%). There was no difference between postprocedure and follow-up peak gradient in the overall cohort (19.3 vs. 18.4 mmHg; p = NS) or in those with ≥10-years follow-up (21.1 vs. 21.1 mmHg; p = NS). Severe SVD occurred in 13 patients (5.9%; median 7.8-years post-TAVI). Three cases (23.1%) were due to regurgitation and 10 (76.9%) to stenosis. Valve-related reintervention/death occurred in 5 patients (2.3%). Severe SVD was more frequent with BEV than SEV (11.9% vs. 3.5%; p = 0.02), driven by a difference in patients treated with small valves (BEV 28.6% vs. SEV 3.0%; p < 0.01). CONCLUSIONS Hemodynamic function of transcatheter heart valves remains stable up to more than 10 years post-TAVI. Severe SVD occurred in 5.9%, and valve-related death/reintervention in 2.3%. Severe SVD was more common with BEV than SEV.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jessica Parker
- Department of Cardiology, Royal Sussex County Hospital, Brighton, UK
| | | | | | - Shuslim Gurung
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | | | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, UK
| | | | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Andrew Wiper
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool, UK
| | - Mamta H Buch
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Adrian P Banning
- Department of Cardiology, Oxford Universities Hospital, Oxford, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Mailey J, Moore JS, Brennan PF, Jing M, Awuah A, McLaughlin JAD, Nesbit MA, Moore CBT, Spence MS. INOCA affects more than the coronaries. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1192] [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
Ischaemia with normal coronary arteries (INOCA) may result in disabling symptoms and has an association with adverse long-term prognosis. The diagnosis of INOCA necessitates invasive coronary angiography to perform a physiological evaluation of microvascular function.
The conjunctiva has a readily assessable microvascular network in which physiological parameters can be evaluated. We compared conjunctival haemodynamics in patients with and without coronary microvascular disease (MVD) to assess if systemic microvascular dysfunction was present in this coronary artery disease sub-group.
Methods
In this study, we recruited patients undergoing invasive coronary angiography for the investigation of angina or angina equivalent symptoms. All patients had physiologically insignificant epicardial disease (FFR≥0.80) and underwent a physiological evaluation of coronary microvascular function. We compared a group with evidence of coronary MVD (IMR≥25 or CFR<2.0); to a group of controls without MVD (IMR<25 and CFR≥2.0).
The conjunctival microvasculature was imaged using a previously validated combination of a smartphone and slit-lamp biomicroscope. The conjunctival vasculature was assessed using a semi-automated process of vessel diameter measurement and erythrocyte tracking to obtain haemodynamic parameters of microvascular function.
Results
A total of 111 patients were included (43 MVD and 68 controls). There were no differences in baseline demographics, co-morbidities, epicardial coronary disease severity or regular pharmacological therapies between the groups. Mean coronary flow reserve (CFR) was lower and mean index of microcirculatory resistance (IMR) higher in the MVD cohort (CFR 2.5±1.3 vs 5.2±2.5, p<0.001 and IMR 28.4±11.8 vs 13.7±5.0, p<0.001).
A total of 2295 conjunctival vessels were analysed. The mean number of vessels per patient was 21.0±12.8 (3.2±3.5 arterioles and 14.8±10.8 venules). Significant reductions in axial/cross-sectional velocity, wall shear rate and wall shear stress were observed in the MVD cohort. Table 1 demonstrates a comparison of conjunctival physiological parameters between the groups.
The most marked differences were observed in conjunctival arterioles. Due to the heterogenous size distribution of microvessels, arterioles were categorised into 2 diameter sub-groups (10–25 μm and 25–40 μm) for analysis (Table 2).
Conclusion
The reductions in microvascular blood flow velocity and rate that form the basis for the diagnosis of coronary microvascular dysfunction can be observed non-invasively in the bulbar conjunctiva microcirculation. Conjunctival vascular imaging may have utility as a non-invasive imaging modality to both diagnose microvascular dysfunction and augment conventional cardiovascular risk stratification.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Belfast Trust Heart Trust Fund and Northern Ireland Chest Heart and Stroke
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Affiliation(s)
- J Mailey
- Royal Victoria Hospital , Belfast , United Kingdom
| | - J S Moore
- University of Ulster , Belfast , United Kingdom
| | - P F Brennan
- Royal Victoria Hospital , Belfast , United Kingdom
| | - M Jing
- University of Ulster , Belfast , United Kingdom
| | - A Awuah
- University of Ulster , Belfast , United Kingdom
| | | | - M A Nesbit
- University of Ulster , Belfast , United Kingdom
| | - C B T Moore
- University of Ulster , Belfast , United Kingdom
| | - M S Spence
- Royal Victoria Hospital , Belfast , United Kingdom
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Mailey J, Brennan P, Cox B, Salman M, Shahmohammodi M, Collins P, Jhadav S, Khan UA, Linden K, Craig A, Owens C, Spence M, McNeice A, Manoharan G. TCT-600 A Comparison of Vascular Closure Devices and Techniques in Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barker M, Sathananthan J, Perdoncin E, Devireddy C, Keegan P, Grubb K, Pop AM, Depta JP, Rai D, Abtahian F, Spence MS, Mailey J, Muir DF, Russo MJ, Pineda-Salazar J, Okoh A, Smith M, Dahle TG, Rana M, Alfadhel M, Meier D, Chatfield A, Akodad M, Chuang A, Samuel R, Nestelberger T, McAlister C, Lauck S, Webb JG, Wood DA. Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic: The Multicenter PROTECT TAVR Study. JACC Cardiovasc Interv 2022; 15:590-598. [PMID: 35331450 PMCID: PMC8936029 DOI: 10.1016/j.jcin.2021.12.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022]
Abstract
Objectives The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic. Background The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands. Methods Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation. Results From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106). Conclusions SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.
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Affiliation(s)
- Madeleine Barker
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Kendra Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Andrei M Pop
- AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Farhad Abtahian
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Douglas F Muir
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mark J Russo
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Pineda-Salazar
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alexis Okoh
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Meghan Smith
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Thom G Dahle
- Department of Cardiology, CentraCare Heart and Vascular Center, St. Cloud, Minnesota, USA
| | - Masud Rana
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mesfer Alfadhel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Chatfield
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chuang
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rohit Samuel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron McAlister
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Lauck
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
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Barker M, Sathananthan J, Perdoncin E, Keegan P, Devireddy C, Grubb K, Pop A, Depta J, Rai D, Spence M, Mailey J, Muir D, Russo M, Okoh A, Smith M, Rana M, Lauck S, Webb J, Wood D. TCT-53 Same-Day Discharge Post-Transcatheter Aortic Valve Replacement Using a Standardized Clinical Pathway During the COVID-19 Pandemic: The PROTECT TAVR Study. J Am Coll Cardiol 2021. [PMCID: PMC8559993 DOI: 10.1016/j.jacc.2021.09.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laffan J, Hogg M, Devlin P, Mailey J, Montgomery J, Johnston N, Spence M, Walsh S. Association between social deprivation status, age of presentation, and survival following ST-segment elevation myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Many factors influence age of presentation with and survival following ST-segment myocardial infarction (STEMI). These include age, mode of, and time-delay to emergency treatment, diabetes and smoking. We sought to assess whether overall social deprivation status is associated with age of presentation and mortality following STEMI patients treated with primary PCI.
Methods
All patients treated emergently for STEMI in a large Northern Irish tertiary hospital from 2013 – 2017 were reviewed. Social deprivation is determined as a composite score relating to income, crime etc, and assigned to small geographical regions by the Northern Ireland Statistics and Research Agency. Deprivation score was assigned to patients based on their postcode. The database was ranked by social deprivation score and divided in to quintiles. The most (Grp 1) and least (Grp 5) deprived quintiles were compared. Mortality was determined from a national electronic health record.
Results
1,192 patients were included in the analysis. Mean follow up was 52.5 months (SD 15.6), minimum follow up was 35.6 months. There was no difference in gender: 70.1% male in Grp 1 vs 75.2% male in Grp 5 (p=0.68); no difference in ECG to balloon time: mean 89.9mins (95% CI 84.9–94.9) Grp 1 vs 90.5mins (95% CI 86.2–94.9) Grp 5 (p=0.86). The more deprived group was younger: mean age 60.6 (95% CI 59.5–61.6) vs 65.2 (95% CI 64.2–66.3) (p<0.000). Crude survival measured by Log-rank test was the same between the groups (p=0.52). Following Cox-regression adjustment for age, survival was longer in the least deprived group (p=0.042).
Conclusion
Social deprivation is associated with both a younger age of presentation with, and a higher mortality following STEMI. This is important variable is often overlooked in medical literature and should be further studied.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Laffan
- Royal Victoria Hospital, Belfast, United Kingdom
| | - M Hogg
- Royal Victoria Hospital, Belfast, United Kingdom
| | - P Devlin
- Royal Victoria Hospital, Belfast, United Kingdom
| | - J Mailey
- Royal Victoria Hospital, Belfast, United Kingdom
| | - J Montgomery
- Royal Victoria Hospital, Belfast, United Kingdom
| | - N Johnston
- Royal Victoria Hospital, Belfast, United Kingdom
| | - M Spence
- Royal Victoria Hospital, Belfast, United Kingdom
| | - S Walsh
- Royal Victoria Hospital, Belfast, United Kingdom
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Cosgrove C, Hanratty CG, Hill JM, Mahadevan K, Mailey J, McEntegart M, O'Kane P, Sidik N, Strange JW, Walsh SJ, Wilson S, Yeoh J, Spratt JC. Intravascular lithotripsy for treatment of calcific coronary lesions in ST elevation myocardial infarction. Catheter Cardiovasc Interv 2021; 99:322-328. [PMID: 34051045 DOI: 10.1002/ccd.29801] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/29/2021] [Accepted: 05/17/2021] [Indexed: 01/30/2023]
Abstract
AIMS To describe the utility and safety of intravascular lithotripsy (IVL) in the setting of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). METHODS AND RESULTS We performed a retrospective analysis, across six UK sites of all patients in whom IVL was used for coronary calcium modification of the culprit lesion during primary PCI for STEMI. The 72 patients were included. IVL was used in de-novo culprit lesions in 57 (79%) of cases and culprit in-stent restenoses in 11 (15%) of cases. In four cases (6%) it was used in a newly deployed stent when this was under-expanded due to inadequate calcium modification. Of the 30 cases in which intracoronary imaging was available for stent analysis, the average stent expansion was 104%. Intra-procedural stent thrombosis occurred in one case (1%), and no-reflow in three cases (4%). The 30 day MACE rates were 18%. CONCLUSION IVL appears to be feasible and safe for use in the treatment of calcific coronary artery disease in the setting of STEMI.
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Affiliation(s)
- Claudia Cosgrove
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Colm G Hanratty
- Department of Cardiology, Mater Private Hospital, Dublin, UK
| | - Jonathan M Hill
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Jonathan Mailey
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Peter O'Kane
- Department of Cardiology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Novalia Sidik
- Department of Cardiology, Golden Jubilee Hospital, Clydebank, UK
| | | | - Simon J Walsh
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Simon Wilson
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Julian Yeoh
- Department of Cardiology, Kings College Hospital NHS Foundation Trust, London, UK
| | - James C Spratt
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
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9
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Brennan PF, McNeil AJ, Jing M, Awuah A, Moore JS, Mailey J, Finlay DD, Blighe K, McLaughlin JAD, Nesbit MA, Trucco E, Moore TCB, Spence MS. Assessment of the conjunctival microcirculation for patients presenting with acute myocardial infarction compared to healthy controls. Sci Rep 2021; 11:7660. [PMID: 33828174 PMCID: PMC8027463 DOI: 10.1038/s41598-021-87315-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
Microcirculatory dysfunction occurs early in cardiovascular disease (CVD) development. Acute myocardial infarction (MI) is a late consequence of CVD. The conjunctival microcirculation is readily-accessible for quantitative assessment and has not previously been studied in MI patients. We compared the conjunctival microcirculation of acute MI patients and age/sex-matched healthy controls to determine if there were differences in microcirculatory parameters. We acquired images using an iPhone 6s and slit-lamp biomicroscope. Parameters measured included diameter, axial velocity, wall shear rate and blood volume flow. Results are for all vessels as they were not sub-classified into arterioles or venules. The conjunctival microcirculation was assessed in 56 controls and 59 inpatients with a presenting diagnosis of MI. Mean vessel diameter for the controls was 21.41 ± 7.57 μm compared to 22.32 ± 7.66 μm for the MI patients (p < 0.001). Axial velocity for the controls was 0.53 ± 0.15 mm/s compared to 0.49 ± 0.17 mm/s for the MI patients (p < 0.001). Wall shear rate was higher for controls than MI patients (162 ± 93 s-1 vs 145 ± 88 s-1, p < 0.001). Blood volume flow did not differ significantly for the controls and MI patients (153 ± 124 pl/s vs 154 ± 125 pl/s, p = 0.84). This pilot iPhone and slit-lamp assessment of the conjunctival microcirculation found lower axial velocity and wall shear rate in patients with acute MI. Further study is required to correlate these findings further and assess long-term outcomes in this patient group with a severe CVD phenotype.
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Affiliation(s)
- Paul F Brennan
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK.
| | - Andrew J McNeil
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Min Jing
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, UK
| | - Agnes Awuah
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Julie S Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Dewar D Finlay
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, UK
| | - Kevin Blighe
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - James A D McLaughlin
- Nanotechnology and Integrated Bioengineering Centre (NIBEC), Ulster University, Jordanstown, UK
| | - M Andrew Nesbit
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing (SSEN), University of Dundee, Dundee, UK
| | - Tara C B Moore
- Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
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Abstract
INTRODUCTION A large number of important clinical trials in cardiology were published or presented at major international conferences during 2019. This paper aims to offer a concise overview of these significant advances and to put them into clinical context. METHODS Trials presented at the major international cardiology meetings during 2019 were reviewed including The American College of Cardiology (ACC), Euro PCR, The European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), and the American Heart Association (AHA). In addition to this a literature search identified several other publications eligible for inclusion based on their relevance to clinical cardiology, their potential impact on clinical practice and on future guidelines. RESULTS A total of 70 trials met the inclusion criteria. New interventional and structural data include trials examining use of drug-coated balloons in patients with acute myocardial infarction (MI), interventions following shockable cardiac arrest, mechanical circulatory support in cardiogenic shock complicating MI, intervention in stable coronary artery disease, surgical or percutaneous revascularisation strategies in left main coronary artery disease, revascularisation strategy in ST elevation MI, transcatheter aortic valve replacement in low-risk patients, and percutaneous mitral or tricuspid valve interventions. Preventative cardiology data included the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors (dapagliflozin), proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (evolocumab), bempedoic acid, and novel approaches to the management of hypertension. Antiplatelet data included trials evaluating both the optimal length of course and combination of antiplatelet agents and regimes including combination antithrombotic therapies for patients with atrial fibrillation. Heart failure data included trials of sacubitril-valsartan in heart failure with preserved ejection fraction and the use of SGLT2 inhibitors in patients with heart failure but without diabetes. Electrophysiology data included trials examining alcohol in atrial fibrillation and the use of wearable fitness devices for identifying atrial fibrillation. CONCLUSION This article presents key clinical trials completed during 2019 and should be valuable to clinicians and researchers working in cardiology.
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Affiliation(s)
- Katie Linden
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, UK
| | - Jonathan Mailey
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, UK
| | - Aileen Kearney
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, UK
| | - Ian B A Menown
- Southern Health and Social Care Trust, Craigavon Area Hospital, Craigavon, Northern Ireland, UK.
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Alkhalil M, McCune C, McClenaghan L, Mailey J, Collins P, Kearney A, Todd M, McKavanagh P. Clinical Outcomes of Deferred Revascularisation Using Fractional Flow Reserve in Diabetic Patients. Cardiovasc Revasc Med 2019; 21:897-902. [PMID: 31883978 DOI: 10.1016/j.carrev.2019.12.019] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) is used to assess the functional significance of coronary artery lesions. Diabetic patients are associated with high burden of atherosclerosis and microvascular dysfunction. We studied the clinical outcomes of diabetic patients who underwent FFR-guided deferred revascularisation. METHODS Consecutive patients from a single large volume centre who underwent FFR assessment were included. Clinical endpoints were prospectively collected using the national electronic care records system. The primary endpoint was defined as the four-year risk of the vessel-oriented composite outcome of cardiac death, vessel-related myocardial infarction (VMI), and vessel-related urgent revascularisation (VUR). Absolute FFR values groups (0.81 to 0.85; 0.86 to 0.90; and >0.90) were used to further stratify patient outcomes. RESULTS FFR-guided deferred revascularisation occurred in 860 patients (63%), of whom 159 were diabetic. The primary endpoint was significantly higher in the diabetic compared to the non-diabetic group [HR 1.76 (95%CI 1.08 to 2.88), P = 0.024]. The difference was driven from cardiac death (6.3% vs. 3.0%, P = 0.044) and VMI (5.0% vs. 1.7%, P = 0.012) but not VUR (8.8% vs. 5.1%, P = 0.07). There was a significant decrease in the incidence of the primary endpoint in the diabetic group according to FFR groups (23.6%, 12.3%, 2.4%, P = 0.001) with comparable clinical outcomes in the non-diabetic group (11.8%, 6.4%, 7.4%, P = 0.085). CONCLUSIONS Our study demonstrated an increased risk of death and target vessel MI in diabetic patients undergoing FFR-guided deferred revascularisation compared to non-diabetic group. Nonetheless, FFR remained a useful tool to identify those at future risk, mainly in diabetic patients.
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Affiliation(s)
| | - Claire McCune
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | | | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Patrick Collins
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Aileen Kearney
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Matthew Todd
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Peter McKavanagh
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK; Department of Cardiology, Ulster Hospital, Belfast, UK
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12
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Abstract
We report a case of myocarditis complicating gastroenteritis caused by Campylobacter jejuni The patient had an uncomplicated course and made a full recovery. Cardiac MRI was useful in securing an early diagnosis and establishing baseline heart function. Myocarditis should be considered in younger patients presenting with chest pain and elevations in serum troponin. The occurrence of myocarditis complicating Campylobacter jejuni gastroenteritis is reviewed.
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Affiliation(s)
| | - Jonathan Mailey
- specialty trainee year 3 cardiology, Antrim Hospital, Antrim, UK
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13
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Mailey J, Nicholl D. 3 A retrospective audit of mineralocorticoid receptor antagonist (mra) and device therapy following myocardial infarction (mi) complicated by left ventricular (lv) systolic dysfunction. Heart 2017. [DOI: 10.1136/heartjnl-2017-311726.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Johnston P, Mailey J, Linden K, McKavanagh P. 5 Temporal changes in percutaneous coronary intervention in the elderly: Abstract 5 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Monaghan M, Travers B, Kinsella M, Gallagher J, O'Connell E, Watson C, O'Hanlon R, Ledwidge M, Mailey J, Henderson JA, Dixon L, McDonald K. 30 Lack of specialist involvement in heart failure diagnosis leave concerning gaps in management: an all ireland analysis: Abstract 30 Table 1. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jackson AM, Mailey J, Rocchiccioli JP, Campbell RT, Sonecki P. 22 Retrospective Regional Audit of In-Patient Assessment of Left Ventricular Systolic Function and Guideline-Recommended Prescription of Eplerenone following St-elevation Myocardial Infarction. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McIlhenny J, Kirk M, Mailey J, Jabbar A, Rodger C. Ultrasound in appendicitis – A waste of time? Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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