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Sunderland N, Cheese F, Leadbetter Z, Joshi NV, Mariathas M, Felekos I, Biswas S, Dalton G, Dastidar A, Aziz S, McKenzie D, Kandan R, Khavandi A, Rahbi H, Bourdeaux C, Rooney K, Govier M, Thomas M, Dorman S, Strange J, Johnson TW. Validation of the MIRACLE 2 Score for Prognostication After Out-of-hospital Cardiac Arrest. Interv Cardiol 2023; 18:e29. [PMID: 38213747 PMCID: PMC10782425 DOI: 10.15420/icr.2023.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/22/2023] [Indexed: 01/13/2024] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is associated with very poor clinical outcomes. An optimal pathway of care is yet to be defined, but prognostication is likely to assist in the challenging decision-making required for treatment of this high-risk patient cohort. The MIRACLE2 score provides a simple method of neuro-prognostication but as yet it has not been externally validated. The aim of this study was therefore to retrospectively apply the score to a cohort of OHCA patients to assess the predictive ability and accuracy in the identification of neurological outcome. Methods Retrospective data of patients identified by hospital coding, over a period of 18 months, were collected from a large tertiary-level cardiac centre with a mature, multidisciplinary OHCA service. MIRACLE2 score performance was assessed against three existing OHCA prognostication scores. Results Patients with all-comer OHCA, of presumed cardiac origin, with and without evidence of ST-elevation MI (43.4% versus 56.6%, respectively) were included. Regardless of presentation, the MIRACLE2 score performed well in neuro-prognostication, with a low MIRACLE2 score (≤2) providing a negative predictive value of 94% for poor neurological outcome at discharge, while a high score (≥5) had a positive predictive value of 95%. A high MIRACLE2 score performed well regardless of presenting ECG, with 91% of patients receiving early coronary angiography having a poor outcome. Conclusion The MIRACLE2 score has good prognostic performance and is easily applicable to cardiac-origin OHCA presentation at the hospital front door. Prognostic scoring may assist decision-making regarding early angiographic assessment.
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Affiliation(s)
- Nicholas Sunderland
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Francine Cheese
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Zoe Leadbetter
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Nikhil V Joshi
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Mark Mariathas
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Ioannis Felekos
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Sinjini Biswas
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Geoff Dalton
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | | | - Shahid Aziz
- Cardiology Department, North Bristol NHS Trust Bristol, UK
| | - Dan McKenzie
- Cardiology Department, Royal United Hospital Bath NHS Foundation Trust Combe Park, Bath, UK
| | - Raveen Kandan
- Cardiology Department, Royal United Hospital Bath NHS Foundation Trust Combe Park, Bath, UK
| | - Ali Khavandi
- Cardiology Department, Royal United Hospital Bath NHS Foundation Trust Combe Park, Bath, UK
| | - Hazim Rahbi
- Cardiology Department, Great Western Hospital NHS Foundation Trust Swindon, UK
| | - Christopher Bourdeaux
- Department of Anaesthesia, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Kieron Rooney
- Department of Anaesthesia, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Matt Govier
- Department of Anaesthesia, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Matthew Thomas
- Department of Anaesthesia, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Stephen Dorman
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Julian Strange
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
| | - Thomas W Johnson
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust Bristol, UK
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Perera D, Morgan HP, Ryan M, Dodd M, Clayton T, O’Kane PD, Greenwood JP, Walsh SJ, Weerackody R, McDiarmid A, Amin-Youssef G, Strange J, Modi B, Lockie T, Hogrefe K, Ahmed FZ, Behan M, Jenkins N, Abdelaal E, Anderson M, Watkins S, Evans R, Rinaldi CA, Petrie MC. Arrhythmia and Death Following Percutaneous Revascularization in Ischemic Left Ventricular Dysfunction: Prespecified Analyses From the REVIVED-BCIS2 Trial. Circulation 2023; 148:862-871. [PMID: 37555345 PMCID: PMC10487377 DOI: 10.1161/circulationaha.123.065300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82-1.30]; P=0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01920048.
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MESH Headings
- Humans
- Male
- Aged
- Female
- Stroke Volume
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Ventricular Function, Left
- Arrhythmias, Cardiac/etiology
- Ventricular Dysfunction, Left/etiology
- Defibrillators, Implantable/adverse effects
- Treatment Outcome
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Affiliation(s)
- Divaka Perera
- National Institute for Health Research Biomedical Research Center and British Heart Foundation Center of Research Excellence at the School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (D.P., H.P.M., M.R.)
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (D.P., C.A.R.)
| | - Holly P. Morgan
- National Institute for Health Research Biomedical Research Center and British Heart Foundation Center of Research Excellence at the School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (D.P., H.P.M., M.R.)
| | - Matthew Ryan
- National Institute for Health Research Biomedical Research Center and British Heart Foundation Center of Research Excellence at the School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (D.P., H.P.M., M.R.)
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine, United Kingdom (M.D., T.C., R.E.)
| | - Tim Clayton
- London School of Hygiene & Tropical Medicine, United Kingdom (M.D., T.C., R.E.)
| | - Peter D. O’Kane
- Royal Bournemouth and Christchurch Hospital, Bournemouth, United Kingdom (P.D.O.)
| | - John P. Greenwood
- Leeds Teaching Hospitals NHS Trust and University of Leeds, United Kingdom (J.P.G., M.A.)
| | - Simon J. Walsh
- Belfast Health and Social Care NHS Trust, United Kingdom (S.J.W.)
| | | | - Adam McDiarmid
- Newcastle Hospitals NHS Foundation Trust, United Kingdom (A.M.)
| | - George Amin-Youssef
- King’s College Hospital NHS Foundation Trust, London, United Kingdom (G.A.-Y.)
| | - Julian Strange
- University Hospitals Bristol NHS Foundation Trust, United Kingdom (J.S.)
| | - Bhavik Modi
- University Hospitals of Leicester NHS Trust, United Kingdom (B.M.)
| | | | - Kai Hogrefe
- Kettering General Hospital, Northampton, United Kingdom (K.H.)
| | - Fozia Z. Ahmed
- Manchester Royal Infirmary, University NHS Foundation Trust, United Kingdom (F.Z.A.)
| | - Miles Behan
- Edinburgh Royal Infirmary, United Kingdom (M.B.)
| | | | | | - Michelle Anderson
- Leeds Teaching Hospitals NHS Trust and University of Leeds, United Kingdom (J.P.G., M.A.)
| | - Stuart Watkins
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.W., M.C.P.)
| | - Richard Evans
- London School of Hygiene & Tropical Medicine, United Kingdom (M.D., T.C., R.E.)
| | | | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.W., M.C.P.)
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Ryan M, De Silva K, Morgan H, O’Gallagher K, Demir OM, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah AM, Chiribiri A, Perera D. Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability. Circ Cardiovasc Interv 2022; 15:e012394. [PMID: 36538582 PMCID: PMC9760472 DOI: 10.1161/circinterventions.122.012394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. METHODS Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. RESULTS Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2 s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2 s-1 had 86% sensitivity and 76% specificity. CONCLUSIONS Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
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Affiliation(s)
- Matthew Ryan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kalpa De Silva
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Holly Morgan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kevin O’Gallagher
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ozan M. Demir
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Haseeb Rahman
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Howard Ellis
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Luke Dancy
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | - Daniel Sado
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | | | | | - Michael Marber
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ajay M. Shah
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Amedeo Chiribiri
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
- Imaging Sciences Division, King’s College London, UK (A.C.)
| | - Divaka Perera
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
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4
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Ryan M, Morgan H, O'Gallagher K, Demir O, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah A, De Silva K, Chiribiri A, Perera D. Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2013] [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: 11/15/2022] Open
Abstract
Abstract
Background
Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.
Objectives
We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).
Methods
Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.
Results
Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.
Conclusions
Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- M Ryan
- King's College London , London , United Kingdom
| | - H Morgan
- King's College London , London , United Kingdom
| | | | - O Demir
- King's College London , London , United Kingdom
| | - H Rahman
- King's College London , London , United Kingdom
| | - H Ellis
- King's College London , London , United Kingdom
| | - L Dancy
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Sado
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - J Strange
- Bristol Heart Institute , Bristol , United Kingdom
| | - N Melikian
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Marber
- King's College London , London , United Kingdom
| | - A Shah
- King's College London , London , United Kingdom
| | - K De Silva
- King's College London , London , United Kingdom
| | - A Chiribiri
- King's College London , London , United Kingdom
| | - D Perera
- King's College London , London , United Kingdom
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Biswas S, Hung J, Durham J, Smail M, Jones M, Spratt J, Strange J. TCT-248 Systematic Comparison of the Efficacy of Various Radiation Protection Devices in Reducing Operator Scatter Radiation Dose in the Cardiac Catheterisation Laboratory. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.292] [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: 10/14/2022]
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6
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Strange J, Ali Z, Holland M, Gaillemin O. Improving and Sustaining the Quality of Discharge Summaries. Acute Med 2022; 21:139-145. [PMID: 36427212 DOI: 10.52964/amja.0913] [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] [Indexed: 06/16/2023]
Abstract
High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.
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Affiliation(s)
- J Strange
- BSc(Hons), MB ChB(Hons); ACCS CT1; Salford Care Organisation, Northern Care Alliance
| | - Z Ali
- BA (Hons) MB BChir; FY2; Salford Care Organisation, Northern Care Alliance, Stott Lane, Salford M6 8HD
| | - M Holland
- MB, BS, MEd, FRCP, FHEA; Associate TIRI Professor, Department of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton. ORCHID ID 0000-0001-8336-5336
| | - O Gaillemin
- MB ChB, PGDip, MRCP; Consultant Physician in Acute Medicine, Salford Care Organisation, Northern Care Alliance
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7
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Lindsay H, Deeny A, Irwin R, Strange J. Developing a Communication System During the COVID Crisis for the Relatives of Critically Ill Patients. Ulster Med J 2021; 90:90-95. [PMID: 34276087 PMCID: PMC8278942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/05/2022]
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De Silva K, Myat A, Strange J, Weisz G. Iterative Improvement and Marginal Gains in Coronary Revascularisation: Is Robot-assisted Percutaneous Coronary Intervention the New Hope? Interv Cardiol 2020; 15:e18. [PMID: 33376506 PMCID: PMC7756352 DOI: 10.15420/icr.2020.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022] Open
Abstract
Percutaneous coronary intervention (PCI) has undergone a rapid and adaptive evolution since its introduction into clinical practice more than 40 years ago. It is the most common mode of coronary revascularisation in use, with the scope, breadth and constellation of disease being treated increasing markedly over time. This has principally been driven by improvements in technology, engineering and training in the field, which has facilitated more complex PCI procedures to be undertaken safely. Robot-assisted PCI represents the next paradigm shift in contemporary PCI practice. It has the ability to enhance procedural accuracy for the patient while improving radiation safety and ergonomics for the operator. This state-of-the-art review outlines the current position and future potential of robot-assisted PCI.
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Affiliation(s)
- Kalpa De Silva
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust and University of Bristol Bristol, UK
| | - Aung Myat
- Frimley Park Hospital, Frimley Health NHS Foundation Trust Camberley, UK
| | - Julian Strange
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust and University of Bristol Bristol, UK
| | - Giora Weisz
- Columbia University Medical Center New York, NY, US
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9
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Connolly G, Mora J, Sammut E, Kashyap M, Dastidar A, Gall A, De Silva K, Joshi N, Dorman S, Strange J, Johnson T. How relevant is the ISCHEMIA trial to a rapid access chest pain clinic cohort of patients? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1414] [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
The ISCHEMIA trial demonstrated that optimal medical therapy (OMT) is not inferior to an early interventional approach for stable angina. This could significantly impact on clinical practice. This study aimed to check the relevance of the ISCHEMIA trial in a real-world population of patients referred to a tertiary centre with recent onset chest pain (CP).
Methods
In this registry study, electronic notes of all patients assessed in a Rapid Access Chest Pain Clinic (RACPC) within a 12-month period (2018–19) were reviewed. Patients were selected if they met key ISCHEMIA trial inclusion criteria.
Results
2416 patients were assessed, 378 (15.6%) presented with typical anginal CP, 1357 (56.2%) had atypical CP and 681 (28.2%) had non anginal CP.
Of the typical CP group, 158 patients were excluded (91 known CAD, 62 ACS, 2 eGFR <30mL/min, 3 severe LVSD). This resulted in 220 patients, representing 58.2% of the typical chest pain population and 9.1% of all patients seen in RACPC. These patients had a median age of 60 years, 96 (44%) female, 119 (54.1%) had high cholesterol, 44 (20%) had diabetes, 115 (52.3%) had hypertension, 104 (47.3%) had a family history of ischaemic heart disease, and 32 (14.5%) were current smokers.
Of these 220 patients, 48 (21.8%) had a CT coronary angiogram (CTCA) requested as their first line investigation (42 completed) with 1 (2.4%) patients result suggestive of significant left main stem (LMS) disease. 15 (6.8%) patients had stress echocardiography requested as their first line investigation (13 completed), 4 (31%) were positive for inducible ischaemia. 3 (1.4%) patients had stress CMR requested as their first line investigation (2 completed), both were negative. 143 (65%) patients had an invasive coronary angiogram (ICA) requested as their first line investigation (112 completed). 8 patients had severe LMS disease and were referred for surgical opinion. A further 11 patients were referred for surgical opinion due to multivessel disease or aberrant coronary anatomy. In total 24 (21.4%) patients were treated with PCI following ICA as their first line investigation.
All patients were started on medical therapy for presumed CAD with up-titration while awaiting investigations. The median wait time for a CTCA was 55 days compared to 165.5 days for ICA.
Two patients (0.9%) from the cohort of 220 patients died during the follow up period, compared to 2.5% of patients admitted from RACPC with an ACS diagnosis.
Conclusion
Patients present with undifferentiated chest pain, consequently the outcomes of the ISCHEMIA trial must be considered cautiously. Within our cohort of 2416 patients, only 9% of patients met key inclusion criteria of the trial. Ultimately, only 19.5% patients with typical chest pain were revascularised, unlike 80% of patients in the invasive arm of ISCHEMIA. It is unclear how the results of the ISCHEMIA trial will impact on UK practice, but it is clear that OMT plays a central role.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - J Mora
- Bristol Heart Institute, Bristol, United Kingdom
| | - E Sammut
- University of Bristol, Bristol, United Kingdom
| | - M Kashyap
- Bristol Heart Institute, Bristol, United Kingdom
| | - A Dastidar
- Bristol Heart Institute, Bristol, United Kingdom
| | - A Gall
- Bristol Heart Institute, Bristol, United Kingdom
| | - K De Silva
- Bristol Heart Institute, Bristol, United Kingdom
| | - N Joshi
- Bristol Heart Institute, Bristol, United Kingdom
| | - S Dorman
- Bristol Heart Institute, Bristol, United Kingdom
| | - J Strange
- Bristol Heart Institute, Bristol, United Kingdom
| | - T Johnson
- Bristol Heart Institute, Bristol, United Kingdom
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Yeoh J, Cottens D, Cosgrove C, Mallek K, Strange J, Anderson R, Wilson S, Hanratty C, Walsh S, McEntegart M, Hill J, Spratt JC. Management of stent underexpansion using intravascular lithotripsy—Defining the utility of a novel device. Catheter Cardiovasc Interv 2020; 97:22-29. [DOI: 10.1002/ccd.28715] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/09/2019] [Revised: 12/12/2019] [Accepted: 12/29/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Julian Yeoh
- Department of Cardiology, King's College Hospital NHS Foundation Trust London UK
| | - Daan Cottens
- Department of Cardiology, St George's University Hospital NHS Foundation Trust London UK
| | - Claudia Cosgrove
- Department of Cardiology, St George's University Hospital NHS Foundation Trust London UK
| | - Khaled Mallek
- Department of Cardiology, St George's University Hospital NHS Foundation Trust London UK
| | - Julian Strange
- Department of Cardiology, University Hospitals Bristol NHS Foundation Trust London UK
| | - Richard Anderson
- Department of Cardiology, Cardiff and Vale NHS Foundation Trust Wales UK
| | - Simon Wilson
- Department of Cardiology, Belfast Health and Social Care Trust Belfast UK
| | - Colm Hanratty
- Department of Cardiology, Belfast Health and Social Care Trust Belfast UK
| | - Simon Walsh
- Department of Cardiology, Belfast Health and Social Care Trust Belfast UK
| | | | - Jonathan Hill
- Department of Cardiology, King's College Hospital NHS Foundation Trust London UK
| | - James C. Spratt
- Department of Cardiology, St George's University Hospital NHS Foundation Trust London UK
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11
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Dastidar AG, Baritussio A, De Garate E, Drobni Z, Biglino G, Singhal P, Milano EG, Angelini GD, Dorman S, Strange J, Johnson T, Bucciarelli-Ducci C. Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries. JACC Cardiovasc Imaging 2019; 12:1973-1982. [PMID: 30772224 DOI: 10.1016/j.jcmg.2018.12.023] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [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: 06/06/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to assess the prognostic impact of cardiac magnetic resonance (CMR) and conventional risk factors in patients with myocardial infarction with nonobstructed coronaries (MINOCA). BACKGROUND Myocardial infarction with nonobstructed coronary arteries (MINOCA) represents a diagnostic dilemma, and the prognostic markers have not been clarified. METHODS A total of 388 consecutive patients with MINOCA undergoing CMR assessment were identified retrospectively from a registry database and prospectively followed for a primary clinical endpoint of all-cause mortality. A 1.5-T CMR was performed using a comprehensive protocol (cines, T2-weighted, and late gadolinium enhancement sequences). Patients were grouped into 4 categories based on their CMR findings: myocardial infarction (MI) (embolic/spontaneous recanalization), myocarditis, cardiomyopathy, and normal CMR. RESULTS CMR (performed at a median of 37 days from presentation) was able to identify the cause for the troponin rise in 74% of the patients (25% myocarditis, 25% MI, and 25% cardiomyopathy), whereas a normal CMR was identified in 26%. Over a median follow-up of 1,262 days (3.5 years), 5.7% patients died. The cardiomyopathy group had the worst prognosis (mortality 15%; log-rank test: 19.9; p < 0.001), MI had 4% mortality, and 2% in both myocarditis and normal CMR. In a multivariable Cox regression model (including clinical and CMR parameters), CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation electrocardiogram (ECG) remained the only 2 significant predictors of mortality. Using presentation with ECG ST-segment elevation and CMR diagnosis of cardiomyopathy as risk markers, the mortality risk rates were 2%, 11%, and 21% for presence of 0, 1, and 2 factors, respectively (p < 0.0001). CONCLUSIONS In a large cohort of patients with MINOCA, CMR (median 37 days from presentation) identified a final diagnosis in 74% of patients. Cardiomyopathy had the highest mortality, followed by MI. The strongest predictors of mortality were a CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation ECG.
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Affiliation(s)
- Amardeep Ghosh Dastidar
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Anna Baritussio
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Estefania De Garate
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Bristol National Institute of Health Research, Biomedical Research Centre, Bristol, United Kingdom
| | - Zsofia Drobni
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Giovanni Biglino
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Priyanka Singhal
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Elena G Milano
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Bristol National Institute of Health Research, Biomedical Research Centre, Bristol, United Kingdom
| | - Stephen Dorman
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Julian Strange
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Thomas Johnson
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Bristol National Institute of Health Research, Biomedical Research Centre, Bristol, United Kingdom.
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12
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McAlindon E, Pufulete M, Harris J, Lawton C, Johnson T, Strange J, Baumbach A, Bucciarelli-Ducci C. Microvascular dysfunction determines infarct characteristics in patients with reperfused ST-segment elevation myocardial infarction: The MICROcirculation in Acute Myocardial Infarction (MICRO-AMI) study. PLoS One 2018; 13:e0203750. [PMID: 30422990 PMCID: PMC6233915 DOI: 10.1371/journal.pone.0203750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with reperfused ST-elevation myocardial infarction (STEMI) both invasive and non-invasive assessments of microvascular dysfunction, the index of microcirculatory resistance (IMR), and microvascular obstruction (MVO) by cardiovascular magnetic resonance (CMR), independently predict poor long-term outcomes. AIMS The aims of this study were to investigate whether an invasive parameter (IMR), assessed at the time of primary percutaneous intervention (PPCI), could predict the extent of MVO in proportion to infarct size (MVO index). METHODS 50 patients presenting with STEMI and TIMI flow ≤ I in the infarct related artery were prospectively recruited to the study, before undergoing PPCI. All patients underwent invasive IMR assessment at maximal hyperaemia using adenosine, and following stent insertion. CMR was performed on day 2 following STEMI, MVO was assessed both on first-pass rest perfusion (early MVO) and in the late gadolinium enhancement (LGE) images (late MVO) along with infarct size. The MVO index was calculated as the ratio of late MVO/infarct size. Differences between IMR quartiles and the MVO index were investigated. RESULTS The median IMR was 38.5 (range 9 to 202). The median size of late MVO was 1.9% LV (range 0 to 21.0% LV). IMR predicted late MVO (p<0.01) and as IMR increased, the MVO index increased (r = 0.70, [95% CI 0.53, 0.82], p<0.001). An IMR cut-off of 40 significantly predicted the presence of late MVO on CMR (p<0.001). CONCLUSION IMR measured at the time of PPCI in acutely reperfused STEMI is associated with the presence and severity of infarct damage as measured by the MVO index. TRIAL REGISTRATION The Microcirculation in Acute Myocardial Infarction (MICRO-AMI). Clinicaltrials.gov NCT01552564. Registered 9th March 2012.
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Affiliation(s)
- Elisa McAlindon
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
- Heart and Lung Institute, New Cross Hospital, Wolverhampton, United Kingdom
| | - Maria Pufulete
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
| | - Jessica Harris
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
| | - Chris Lawton
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
| | - Tom Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
| | - Julian Strange
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
- Barts Heart Centre, William Harvey Research Institute, Queen Mary University London, United Kingdom
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
- Bristol NIHR Cardiovascular Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
- * E-mail:
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13
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Kinnaird T, Gallagher S, Cockburn J, Sirker A, Ludman P, de Belder M, Smith E, Anderson R, Strange J, Mamas M, Hildick-Smith D. Procedural Success and Outcomes With Increasing Use of Enabling Strategies for Chronic Total Occlusion Intervention. Circ Cardiovasc Interv 2018; 11:e006436. [DOI: 10.1161/circinterventions.118.006436] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A.)
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A.)
| | - James Cockburn
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (J.C., D.H.-S.)
| | - Alex Sirker
- Department of Cardiology, University College Hospital, London, United Kingdom (A.S.)
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.)
| | - Mark de Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.)
| | - Elliot Smith
- Department of Cardiology, St Bartholomew’s Hospital, London, United Kingdom (E.S.)
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., S.G., R.A.)
| | - Julian Strange
- Department of Cardiology, Bristol Royal Infirmary, United Kingdom (J.S.)
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent and Royal Stoke Hospital, University Hospital of North Midlands, United Kingdom (M.M.)
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom (J.C., D.H.-S.)
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14
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Kinnaird T, Cockburn J, Sirker A, Ludman P, de Belder M, Smith E, Anderson R, Strange J, Mamas M, Hildick-Smith D. TCT-77 Procedural success and outcomes with increasing use of enabling strategies for chronic total occlusion intervention: an analysis of 28,050 cases from the British Cardiovascular Intervention Society database. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1170] [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: 11/29/2022]
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15
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Ghosh Dastidar A, De Garate E, Drobni Z, Baritussio A, Singhal P, Biglino G, Dorman S, Strange J, Baumbach A, Johnson T, Bucciarelli-Ducci C. P2122Prognostic risk stratification in myocardial infarction with non-obstructed coronaries (MINOCA) by conventional risk factors and cardiac magnetic resonance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2122] [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: 11/12/2022] Open
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16
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Kinnaird T, Anderson R, Ossei-Gerning N, Cockburn J, Sirker A, Ludman P, deBelder M, Walsh S, Smith E, Hanratty C, Spratt J, Strange J, Hildick-Smith D, Mamas MA. Legacy Effect of Coronary Perforation Complicating Percutaneous Coronary Intervention for Chronic Total Occlusive Disease. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004642. [DOI: 10.1161/circinterventions.116.004642] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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] [Received: 10/20/2016] [Accepted: 04/11/2017] [Indexed: 11/16/2022]
Abstract
Background—
Coronary perforation (CP) during chronic total occlusion percutaneous coronary intervention for stable angina (CTO-PCI) is a rare but serious event. The evidence base is limited, and the long-term effects are unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during CTO-PCI were defined.
Methods and Results—
Data analyzed from the British Cardiovascular Intervention Society data set on all CTO-PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. A total of 376 CP were recorded from 26 807 CTO-PCI interventions (incidence of 1.40%) with an increase in frequency during the study period (
P
=0.012). Patient-related factors associated with an increased risk of CP were age and female sex. Procedural factors indicative of complex CTO intervention strongly related to an increased risk of CP with a close relationship between the number of complex strategies used and CP evident (
P
=0.008 for trend). Tamponade occurred in 16.6% and emergency surgery in 3.4% of cases. Adverse outcomes were frequent in those patients with perforation including bleeding, transfusion, myocardial infarction, and death. A legacy effect of perforation on mortality was evident, with an odds ratio for 12-month mortality of 1.60 for perforation survivors compared with matched nonperforation survivors without a CP (
P
<0.0001).
Conclusions—
Many of the factors associated with an increased risk of CP were related to CTO complexity. Perforation was associated with adverse outcomes, with a legacy effect on later mortality after CP also observed.
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Affiliation(s)
- Tim Kinnaird
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Richard Anderson
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Nicholas Ossei-Gerning
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - James Cockburn
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Alex Sirker
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Peter Ludman
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Mark deBelder
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Simon Walsh
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Elliot Smith
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Colm Hanratty
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - James Spratt
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Julian Strange
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - David Hildick-Smith
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
| | - Mamas A. Mamas
- From the Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K., R.A., N.O.-G.); Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom (J.C., D.H.-S.); Department of Cardiology, University College Hospital, London, United Kingdom (A.S.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough
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17
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Wilson WM, Walsh SJ, Bagnall A, Yan AT, Hanratty CG, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Douglas H, Strange J, Spratt JC. One-year outcomes after successful chronic total occlusion percutaneous coronary intervention: The impact of dissection re-entry techniques. Catheter Cardiovasc Interv 2017; 90:703-712. [PMID: 28296045 DOI: 10.1002/ccd.26980] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 07/10/2016] [Revised: 01/07/2017] [Accepted: 01/17/2017] [Indexed: 11/10/2022]
Abstract
We aimed to determine clinical outcomes 1 year after successful chronic total occlusion (CTO) PCI and, in particular, whether use of dissection and re-entry strategies affects clinical outcomes. Hybrid approaches have increased the procedural success of CTO percutaneous coronary intervention (PCI) but longer-term outcomes are unknown, particularly in relation to dissection and re-entry techniques. Data were collected for consecutive CTO PCIs performed by hybrid-trained operators from 7 United Kingdom (UK) centres between 2012 and 2014. The primary endpoint (death, myocardial infarction, unplanned target vessel revascularization) was measured at 12 months along with angina status. One-year follow up data were available for 96% of successful cases (n = 805). In total, 85% of patients had a CCS angina class of 2-4 prior to CTO PCI. Final successful procedural strategy was antegrade wire escalation 48%; antegrade dissection and re-entry (ADR) 21%; retrograde wire escalation 5%; retrograde dissection and re-entry (RDR) 26%. Overall, 47% of CTOs were recanalized using dissection and re-entry strategies. During a mean follow up of 11.5 ± 3.8 months, the primary endpoint occurred in 8.6% (n = 69) of patients (10.3% (n = 39/375) in DART group and 7.0% (n = 30/430) in wire-based cases). The majority of patients (88%) had no or minimal angina (CCS class 0 or 1). ADR and RDR were used more frequently in more complex cases with greater disease burden, however, the only independent predictor of the primary endpoint was lesion length. CTO PCI in complex lesions using the hybrid approach is safe, effective and has a low one-year adverse event rate. The method used to recanalize arteries was not associated with adverse outcomes. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- W M Wilson
- Royal Melbourne Hospital, Department of Cardiology, Parkville VIC 3050, Melbourne, Australia
| | - S J Walsh
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - A Bagnall
- Freeman Hospital, Cardiothoracic Services, Newcastle upon Tyne, England.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England
| | - A T Yan
- Division Cardiology, St Michael's Hospital, University of Toronto, Canada
| | - C G Hanratty
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - M Egred
- Freeman Hospital, Cardiothoracic Services, Newcastle upon Tyne, England.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, England
| | - E Smith
- The London Chest Hospital, Barts Health NHS Trust, London, England, United Kingdom
| | - K G Oldroyd
- Golden Jubilee National Hospital, West of Scotland Regional Heart and Lung Centre, Glasgow, Scotland
| | - M McEntegart
- Golden Jubilee National Hospital, West of Scotland Regional Heart and Lung Centre, Glasgow, Scotland
| | - J Irving
- Ninewells Hospital, Dundee, Scotland
| | - H Douglas
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - J Strange
- Bristol Heart Institute, Bristol, United Kingdom
| | - J C Spratt
- Forth Valley Royal Hospital, Larbert, United Kingdom
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18
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Kandan SR, Rahbi H, Rooney K, Thomas M, Mozid A, Dorman S, Baumbach A, Johnson T, Strange J. PREDICTORS OF SURVIVAL FROM OUT-OF-HOSPITAL CARDIAC ARREST. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34485-6] [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: 10/20/2022]
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19
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Sharma V, Wilson W, Smith W, McEntegart M, Oldroyd K, Sidik N, Bagnall A, Egred M, Irving J, Strange J, Johnson T, Walsh S, Hanratty C, Spratt J. Comparison of Characteristics and Complications in Men Versus Women Undergoing Chronic Total Occlusion Percutaneous Intervention. Am J Cardiol 2017; 119:535-541. [PMID: 27923460 DOI: 10.1016/j.amjcard.2016.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 09/09/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 11/18/2022]
Abstract
Gender differences exist in clinical outcomes after routine percutaneous coronary intervention (PCI), but studies reporting such outcomes after chronic total occlusion (CTO) PCI are limited. We assessed the characteristics and outcomes of female patients undergoing CTO PCI. We retrospectively analyzed a dedicated national (United Kingdom) prospective CTO database from 2011 to 2015 for outcomes and characteristics of female patients undergoing CTO PCI (unmatched and propensity matched). Female patients constituted 20.5% (n = 260 of 1,271) of the unmatched cohort and 33.3% (n = 233 of 699) of the matched cohort and were more likely to be older (women aged >70 years, 48% in the unmatched and 45% in the matched cohort). An increased inhospital complication rate was observed in female patients (unmatched: 10% women vs 4.45% men, p = 0.0012, and matched 9.87% women vs 3.86% men, p = 0.0032). Coronary perforation, bleeding, and contrast-induced nephropathy were more frequently observed in female patients. Femoral access site with >6 French sheath was associated with an increased risk of bleeding. Presence of calcification in the CTO artery was associated with coronary perforation (grade III) in female patients in the matched cohort (p = 0.007). Female patients undergoing CTO PCI were older and experienced increased of inhospital complications. Increased awareness of these complications could influence the selection of access site and sheath size, the need for prehydration, judicious choice of balloon size, collateral selection, and wire placement in female patients undergoing CTO PCI.
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Affiliation(s)
- Vinoda Sharma
- Department of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada
| | - William Wilson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - William Smith
- Department of Cardiology, Trent Cardiac Centre, Nottingham City Hospital, Nottingham, United Kingdom
| | - Margaret McEntegart
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Keith Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Novalia Sidik
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Alan Bagnall
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - John Irving
- Department of Cardiology, Ninewells Hospital, Dundee, United Kingdom
| | - Julian Strange
- Department of Cardiology, University Hospitals Bristol, Bristol, United Kingdom
| | - Thomas Johnson
- Department of Cardiology, University Hospitals Bristol, Bristol, United Kingdom
| | - Simon Walsh
- Department of Cardiology, Belfast City Hospital, Belfast, United Kingdom
| | - Colm Hanratty
- Department of Cardiology, Belfast City Hospital, Belfast, United Kingdom
| | - James Spratt
- Department of Cardiology, Forth Valley Royal Hospital, Larbert, United Kingdom.
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Drozd J, Strange J, Wysokińska A, Sobieszek G, Tomaszewski M. Percutaneous recanalisation of chronically occluded coronary arteries with the CrossBoss/Stingray system: first experience (report of three cases). Kardiol Pol 2017; 73:711-21. [PMID: 26390318 DOI: 10.5603/kp.a2015.0069] [Citation(s) in RCA: 2] [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] [Received: 01/21/2015] [Accepted: 03/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Percutaneous coronary interventions (PCI) within chronically occluded coronary arteries remain challenging procedures with a lower success rate compared to classic PCI. However, over the last years we have witnessed many technological advances in the treatment of chronic total occlusion (CTO) including new wires, retrograde approach, subintimal tracking and re-entry technique, all underlying which the current success rate of up to 95% in dedicated centres. Subintimal space wire penetration is no longer a problem that would require terminating the procedure. It is now a desired part of hybrid CTO approach involving both antegrade and retrograde crossing and re-entry. The new device which facilitates controlled dissection and true lumen re-entry is the Boston Scientific Coronary CTO Crossing System consisting of a CrossBoss micro-catheter and Stingray balloon and dedicated wire. METHODS On October 29th and 30th, 2014, percutaneous coronary recanalisation using the CrossBoss/Stingray system was performed in 3 men aged 63-75, with symptoms of stable CCS class II/III angina, without prior myocardial infarction in the area of CTO artery supply and with preserved myocardial contractility. Each patient underwent at least one previous unsuccesful antegrade/retrograde CTO recanalisation procedure. The J-CTO score was 3-4. RESULTS The procedure was successful in all 3 patients: 2 right coronary arteries and 1 left anterior descending artery were opened. In all 3 cases, both the CrossBoss catheter and the Stingray re-entry system were used. Two to three drug eluting stents were implanted in each patient, with the total length of 62-106 mm and final TIMI 3 flow. The mean procedure time was 141 min (130-150 min), mean fluoroscopy time was 53 min (48-56 min), absorbed dose was 4772 mGy (4098-5633 mGy), dose area product was 565,208 cGy × cm² (535,109-590,266 cGy × cm²), and the mean contrast volume was 343 mL (320-350 mL). No procedure-related complications were note except for an asymptomatic increase in high-sensitivity troponin T level up to 157 ng/mL (reference range 0-14 ng/mL) in 1 patient. CONCLUSIONS The Boston Scientific Coronary CTO Crossing System is a useful device for percutaneous recanalisation of chronically occluded coronary arteries. It helps to achieve procedural success in more complex cases within relatively short crossing times and with a limited amount of the contrast agent and X-ray dose.
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Affiliation(s)
- Jakub Drozd
- Laboratory of Invasive Radiology and Cardiac Catheterisation, Hospital of the Ministry of Interior, Lublin, Poland.
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Dastidar AG, Rodrigues JCL, Johnson TW, De Garate E, Singhal P, Baritussio A, Scatteia A, Strange J, Nightingale AK, Angelini GD, Baumbach A, Delgado V, Bucciarelli-Ducci C. Myocardial Infarction With Nonobstructed Coronary Arteries: Impact of CMR Early After Presentation. JACC Cardiovasc Imaging 2017; 10:1204-1206. [PMID: 28109935 DOI: 10.1016/j.jcmg.2016.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/31/2016] [Accepted: 11/10/2016] [Indexed: 12/17/2022]
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Baritussio A, Marra MP, Dastidar AG, Rodrigues J, Zorzi A, Susana A, Scatteia A, Garate ED, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C. Out of hospital cardiac arrest survivors with inconclusive coronary angiogram: impact of cardiovascular magnetic resonance on clinical management and decision-making. J Cardiovasc Magn Reson 2016. [PMCID: PMC5032657 DOI: 10.1186/1532-429x-18-s1-o62] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Strange J, Cox K, Jones A. P99 Cystic fibrosis medications at transfer from paediatric to adult care – what are patients actually taking? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.242] [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: 11/04/2022]
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Roy J, Lucking A, Strange J, Spratt JC. The Difference Between Success and Failure: Subintimal Stenting Around an Occluded Stent for Treatment of a Chronic Total Occlusion Due to In-Stent Restenosis. J Invasive Cardiol 2016; 28:E136-E138. [PMID: 27801663] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present a case where conventional wire and equipment passage through the proximal cap of a chronic total occlusion due to in-stent restenosis was not possible. The lesion was then safely and successfully treated by deliberate passage into the subintimal space outside the previous stent with subsequent subintimal dissection and reentry into the true lumen beyond the occlusion. We then stented around the occluded stent, effectively crushing the previous stent in the true lumen and restoring flow by stenting open the new subintimal lumen. Follow-up angiography and optical coherence tomography at 6 months demonstrated good medium-term results.
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Affiliation(s)
- James Roy
- Department of Cardiology, King's College Hospital, Hambleden E Wing, Denmark Hill, London SE5 9RS, United Kingdom.
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Wilson W, Walsh S, Hanratty C, Bagnall A, Yan A, Egred M, Smith E, Oldroyd K, McEntegart M, Irving J, Strange J, Spratt J. One Year Outcomes After Chronic Total Occlusion Percutaneous Coronary Intervention Using the Hybrid Approach. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.430] [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: 11/16/2022]
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Rahbi H, Kandan R, Baumbach A, Cowburn P, Thomas M, Rooney K, Johnson T, Strange J. 102 Early Angiography and Coronary Intervention in Comatose Survivors of Out of Hospital Cardiac: Can the 12-lead ECG be Gatekeeper? Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.102] [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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Wilson WM, Walsh SJ, Yan AT, Hanratty CG, Bagnall AJ, Egred M, Smith E, Oldroyd KG, McEntegart M, Irving J, Strange J, Douglas H, Spratt JC. Hybrid approach improves success of chronic total occlusion angioplasty. Heart 2016; 102:1486-93. [DOI: 10.1136/heartjnl-2015-308891] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/16/2016] [Indexed: 11/04/2022] Open
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Dastidar AG, Rodrigues J, Johnson T, De Garate E, Singhal P, Baritussio A, Scatteia A, Strange J, Nightingale A, Baumbach A, Delgado V, Bucciarelli-Ducci C. 4 Troponin positive acute coronary syndromes and unobstructed coronary arteries: Improved diagnostic and clinical impact by performing cardiovascular magnetic resonance early after presentation. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.4] [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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Dastidar AG, Nightingale AK, Johnson TW, Rodrigues JCL, Carpenter A, Cengarle M, Baritussio A, McAlindon E, Augustine DX, Angelini G, Strange J, Baumbach A, Bucciarelli-Ducci C. 005 Non-invasive stress imaging as a gatekeeper to complete revascularisation in stemi patients with moderate bystander disease at primary percutaneous coronary intervention. Heart 2016. [DOI: 10.1136/heartjnl-2016-309680.5] [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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Greulich S, Meloni A, Nazir SA, Stefan Biesbroek P, Arenja N, Kammerlander AA, Sayeed A, Ricci F, Bernhardt P, Meierhofer C, Devos DG, Ruecker B, Burkhardt B, Kamphuis VP, De Lazzari M, Nederend I, Dux-Santoy L, Cavalcante JL, Rosmini S, Liu B, Fent G, Claessen G, Behar J, Oebel S, Baritussio A, Ranjit Arnold J, Kitterer D, Latus J, Henes J, Kurmann R, Gloekler S, Wahl A, Buss S, Katus H, Bobbo M, Lombardi M, Braun N, Alscher M, Sechtem U, Mahrholdt H, Neri M, Preziosi P, Grassedonio E, Schicchi N, Keilberg P, Pulini S, Facchini E, Positano V, Pepe A, Shetye A, Khan JN, Singh A, Kanagala P, Swarbrick D, Gulsin G, Graham-Brown M, Squire I, Gershlick A, McCann GP, Amier RP, Teunissen PF, Robbers LF, Beek AM, van Rossum AC, Hofman MB, van Royen N, Nijveldt R, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Thomas Z, Korosoglou G, Katus HA, Buss SJ, Schwaiger ML, Duca F, Aschauer S, Marzluf BA, Zotter-Tufaro C, Dalos D, Pfaffenberger S, Bonderman D, Mascherbauer J, Fridman Y, Hackman B, Kadakkal A, Maanja M, Daya HA, Wong TC, Schelbert EB, Barison A, Todiere G, Gaeta R, Galllina S, Emdin M, De Caterina R, Aquaro G, Buckert D, Dyckmanns N, Rottbauer W, Kühn A, Shehu N, Müller J, Stern H, Ewert P, Fratz S, Vogt M, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E, Geiger J, Makki M, Burkhardt B, Kellenberger CJ, Buechel ERV, Kellenberger C, Geiger J, Ruecker B, Buechel EV, Elbaz MS, Kroft LJ, van der Geest RJ, de Roos A, Blom NA, Westenberg JJ, Roest AA, Cipriani A, Susana A, Rizzo S, Giorgi B, Carmelo L, Bertaglia E, Bauce B, Corrado D, Thiene G, Marra MP, Basso C, Iliceto S, Roest A, van den Boogaard P, ten Harkel A, de Geus J, Kroft L, de Roos A, Westenberg J, Kale R, Teixido-Tura G, Maldonado G, Huguet M, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares J, Rijal S, Schindler JT, Gleason TG, Lee JS, Schelbert EB, Bulluck H, Treibel TA, Bhuva A, Abdel-Gadir A, Culotta V, Merghani A, Maestrini V, Herrey AS, Kellman P, Manisty C, Moon JC, Hayer M, Baig S, Shah T, Rooney S, Edwards N, Steeds R, Garg P, Swoboda P, Dobson L, Musa T, Foley J, Haaf P, Greenwood J, Plein S, Schnell F, Bogaert J, Dymarkowski S, Pattyn N, Claus P, Van Cleemput J, Gerche AL, Heidbuchel H, Toth D, Reiml S, Panayiotou M, Claridge S, Jackson T, Sohal M, Webb J, O'Neill M, Brost A, Mountney P, Razavi R, Rhode K, Rinaldi CA, Arya A, Hilbert S, Bollmann A, Hindricks G, Jahnke C, Paetsch I, Dinov B, Perazzolo Marra M, Ghosh Dastidar A, Rodrigues J, Zorzi A, Susana A, Scatteia A, De Garate E, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C, Jerosch-Herold M, Karamitsos TD, Francis JM, Bhamra-Ariza P, Sarwar R, Choudhury R, Selvanayagam JB, Neubauer S. ORAL AB AGORA1362Cardiac Involvement in Patients With Different Rheumatic Disorders1366Gender differences in the development of cardiac complications: a multicentric prospective study in a large cohort of thalassemia major patients1646Comparison of T1-mapping, T2-weighted and contrast-enhanced cine imaging at 3.0T CMR for diagnostic oedema assessment in ST-segment elevation myocardial infarction1375Evaluation of Tissue Changes in Remote Noninfarcted Myocardium after Acute Myocardial Infarction using T1-mapping1377Right ventricular long axis strain – The prognostic value of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging1389The role of the right ventricular insertion point in heart failure patients with preserved ejection fraction: Insights from a cardiovascular magnetic resonance study1398Myocardial fibrosis associates with B-type natriuretic peptide levels and outcomes more than wall stress1478Prognostic Value of Pulmonary Blood Volume by Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure Outpatients – The PROVE-HF Study1370Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary1509Influence of non-invasive hemodynamic CMR parameters on maximal exercise capacity in surgically untreated patients with Ebstein's anomaly1356Proximal aortic stiffening in Turner patients is more pronounced in the presence of a bicuspid valve. A segmental functional MRI study1503Flow pattern and vascular distensibility of the pulmonary arteries in patients after repair of tetralogy of Fallot. Insights from 4D flow CMR1516Myocardial deformation characteristics of the systemic right ventricle after atrial switch operation for transposition of the great arteries1633Three-dimensional vortex formation in patients with a Fontan circulation: evaluation with 4D flow CMR1483Mitral valve prolapse: arrhythmogenic substrates by cardiac magnetic imaging1596Increased local wall shear stress after coarctation repair is associated with descending aorta pulse wave velocity: evaluation with CMR and 4D flow1636Three-dimensional wall shear stress assessed by 4Dflow CMR in bicuspid aortic valve disease1464Cardiac Amyloidosis and Aortic Stenosis – The Convergence of Two Aging Processes1630Blood T1 variability explained in healthy volunteers: an analysis on MOLLI, ShMOLLI and SASHA1408Myocardial deformation on CMR predicts adverse outcomes in carcinoid heart disease - a new marker of risk1492Myocardial Perfusion Reserve and Global Longitudinal Strain in Early Rheumatoid Arthritis1500Exercise CMR to differentiate athlete's heart from patients with early dilated cardiomyopathy1559Real-Time, x-mri guidance to optimise left ventricular lead placement for delivery of cardiac resynchronisation therapy1560The role of Cardiac magnetic resonance imaging in patients undergoing ablation for ventricular tachycardia- Defining the substrate and visualizing the outcome1590Impact of cardiovascular magnetic resonance on clinical management and decision-making of out of hospital cardiac arrest survivors with inconclusive coronary angiogram1561Detection of coronary stenosis at rest using Oxygenation-Sensitive Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew181] [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: 11/14/2022] Open
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McEntegart MB, Badar AA, Ahmad FA, Shaukat A, MacPherson M, Irving J, Strange J, Bagnall AJ, Hanratty CG, Walsh SJ, Werner GS, Spratt JC. The collateral circulation of coronary chronic total occlusions. EUROINTERVENTION 2016; 11:e1596-603. [PMID: 27056120 DOI: 10.4244/eijv11i14a310] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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 Despite advances in understanding the physiological role of collaterals in coronary chronic total occlusions (CTOs), collateral anatomy remains poorly defined. Our aim was to define the anatomy and interventional utility of collaterals within a large population of patients with CTOs. METHODS AND RESULTS We studied the coronary angiograms of 481 patients with 519 CTOs at six centres in the U.K. over four years. Detailed angiographic analysis was performed by interventional cardiologists specialising in CTO percutaneous coronary intervention (PCI). All visible collaterals with a collateral connection (CC) grade ≥1 were recorded. A subgroup of CTOs (n=277) was assessed for interventional capability, defined as whether the collateral supply was able to facilitate retrograde access. We described 45 different collateral patterns: 20 in right coronary artery (RCA), 13 in left anterior descending (LAD), and 12 in circumflex artery CTOs. Septal collaterals from the LAD to the right posterior descending artery (RPDA), and from the posterior descending artery to the LAD were most common, and most often considered as having "interventional capability". CONCLUSIONS This is the largest analysis of collateral circulation anatomy in a population of patients with CTOs. We anticipate that these data will be of significant benefit in angiographic analysis and procedure planning for CTO PCI.
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McAlindon E, Dastidar AG, Ahmed N, Lawton CB, Johnson T, Strange J, Baumbach A, Bucciarelli-Ducci C. T2 values of the acutely infarcted myocardium following primary PCI: the relationship with infarct characteristics and gadolinium extracellular volume of distribution. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328561 DOI: 10.1186/1532-429x-17-s1-p138] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dastidar AG, Singhal P, Rodrigues JC, Ahmed N, Palazzuoli A, Townsend M, Nightingale AK, Johnson T, Strange J, Baumbach A, Bucciarelli-Ducci C. Improved diagnostic role of CMR in acute coronary syndromes and unobstructed coronary arteries: the importance of time-to-CMR. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328297 DOI: 10.1186/1532-429x-17-s1-o87] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Bakos Z, Harnek J, Jenkins N, Johnson T, Strange J, Asimakopoulos G, Baumbach A, Kliger C, Ruiz CE. How should I treat an accidentally misplaced 8 Fr drainage catheter in the right ventricle? EUROINTERVENTION 2015; 10:768-70. [PMID: 24682506 DOI: 10.4244/eijv10i61a131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zoltan Bakos
- Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden
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Singhal P, Dastidar AG, Rodrigues JC, Ahmed N, Palazzuoli A, Townsend M, Nightingale A, Johnson T, Strange J, Baumbach A, Bucciarelli-Ducci C. 127 Early Versus Late CMR in Troponin-Positive Chest Pain with Unobstructed Coronaries. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.127] [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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Dastidar AG, Carpenter A, McAlindon E, Johnson T, Strange J, Nightingale AK, Baumbach A, Bucciarelli-Ducci C. Stress CMR as a gatekeeper to complete revascularisation in STEMI patients with moderate-severe bystander disease at primary percutaneous coronary intervention. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328157 DOI: 10.1186/1532-429x-17-s1-o29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wilson W, Walsh S, Hanratty C, Douglas H, McEntegart M, Oldroyd K, Bagnall A, Egred M, Irving J, Smith E, Strange J, Spratt J. 30-day Outcomes From The UK Hybrid CTO Registry. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lesiak M, Strange J. The great debate: "primary PCI for STEMI: an emergency!". EUROINTERVENTION 2014; 10 Suppl T:T32-4. [PMID: 25256531 DOI: 10.4244/eijv10sta6] [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: 11/23/2022]
Affiliation(s)
- Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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Dastidar AG, Ahmed N, McAlindon E, Lawton C, Manghat N, Hamilton M, Strange J, Bucciarelli-Ducci C. 134 Incremental Value of Cardiovascular Magnetic Resonance Imaging in Patients Surviving non Traumatic out of Hospital Cardiac Arrest: A Tertiary UK Centre Experience. Heart 2014. [DOI: 10.1136/heartjnl-2014-306118.134] [Citation(s) in RCA: 2] [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: 11/04/2022] Open
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Williams R, Asrress K, Yousuff M, Goodwin C, Lumley M, Khawaja M, Myat A, Arri S, Patterson T, Lockie T, Nagel E, Perera D, Marber M, Chiribiri A, Redwood S, Plein S, Feistritzer H, Klug G, Reinstadler S, Mair J, Schocke M, Franz W, Metzler B, McGraw S, Mirza O, Bauml M, Gonzalez R, Dickens C, Farzaneh-Far A, McAlindon E, Vizzi V, Strange J, Edmond J, Johnson T, Baumbach A, Bucciarelli-Ducci C, Pharithi R, Meela M, Conway M, Kropmans T, Newell M, Aquaro G, Frijia F, Positano V, Santarelli M, Wiesinger F, Lionetti V, Giovannetti G, Schulte R, Landini L, Menichetti L, Amzulescu M, Rousseau M, Ahn S, de Ravenstein C, Vancraeynest D, Pasquet A, Vanoverschelde J, Pouleur A, Gerber B, Pfaffenberger S, Fandl T, Marzluf B, Babayev J, Juen K, Schenk P, Binder T, Vonbank K, Mascherbauer J, Almeida A, Sa A, Brito D, David C, Marques J, Almeida A, Silva D, de Sousa J, Diogo A, Pinto F, Masci P, Del Torto A, Barison A, Aquaro G, Chiappino S, Vergaro G, Passino C, Emdin M, Saba S, Sachdev V, Hannoush H, Axel L, Arai A, Mykhailova L, Kravchun P, Lapshina L. These abstracts have been selected for moderated presentations on SCREEN A. Please refer to the the PROGRAM and the infos on the screen for more details about schedule, moderators and presenters. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu084] [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: 11/13/2022] Open
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de Belder A, de la Torre Hernandez JM, Lopez-Palop R, O'Kane P, Hernandez Hernandez F, Strange J, Gimeno F, Cotton J, Diaz Fernandez JF, Carrillo Saez P, Thomas M, Pinar E, Curzen N, Baz JA, Cooter N, Lozano I, Skipper N, Robinson D, Hildick-Smith D. A Prospective Randomized Trial of Everolimus-Eluting Stents Versus Bare-Metal Stents in Octogenarians. J Am Coll Cardiol 2014; 63:1371-5. [PMID: 24216285 DOI: 10.1016/j.jacc.2013.10.053] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/01/2013] [Accepted: 10/08/2013] [Indexed: 11/26/2022]
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Wilson WM, Walsh S, Hanratty C, Strange J, Hill J, Sapontis J, Spratt JC. A novel approach to the management of occlusive in-stent restenosis (ISR). EUROINTERVENTION 2014; 9:1285-93. [DOI: 10.4244/eijv9i11a218] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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McAlindon E, Johnson T, Strange J, Edmond J, Harris J, Pufulete M, Baumbach A, Bucciarelli-Ducci C. The association between microvascular obstruction by CMR and the index of microcirculatory resistance assessed invasively. J Cardiovasc Magn Reson 2014. [PMCID: PMC4043231 DOI: 10.1186/1532-429x-16-s1-p212] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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de Belder A, de la Torre Hernandez JM, Lopez-Palop R, O'Kane P, Hernandez Hernandez F, Strange J, Gimeno F, Cotton J, Diaz Fernandez JF, Carrillo Saez P, Thomas M, Pinar E, Curzen N, Baz JA, Cooter N, Lozano I, Skipper N, Robinson D, Hildick-Smith D. A prospective randomized trial of everolimus-eluting stents versus bare-metal stents in octogenarians: the XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly). J Am Coll Cardiol 2013. [PMID: 24216285 DOI: 10.1016/s0735-1097(13)61664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina. BACKGROUND Patients ≥80 years of age frequently have complex coronary disease warranting DES but have a higher risk of bleeding from prolonged dual antiplatelet therapy. METHODS This multicenter randomized trial was conducted in 22 centers in the United Kingdom and Spain. Patients ≥80 years of age underwent stent placement for angina. The primary endpoint was a 1-year composite of death, myocardial infarction, cerebrovascular accident, target vessel revascularization, or major hemorrhage. RESULTS In total, 800 patients (83.5 ± 3.2 years of age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome (68%). Procedural success did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07). Thirty-eight percent of patients had ≥2-vessel percutaneous coronary intervention, and 66% underwent complete revascularization. Patients who received BMS had shorter stent implants (24.0 ± 13.4 mm vs. 26.6 ± 14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for patients in the BMS group and 94.0% for patients in the DES group. The primary endpoint occurred in 18.7% of patients in the BMS group versus 14.3% of patients in the DES group (p = 0.09). There was no difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS group. CONCLUSIONS BMS and DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent-Management of Angina in the Elderly [XIMA]; ISRCTN92243650).
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Affiliation(s)
- Adam de Belder
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England.
| | | | | | - Peter O'Kane
- Royal Bournemouth Hospital, Bournemouth, England
| | | | | | | | - James Cotton
- Royal Wolverhampton Hospital, Wolverhampton, England
| | | | | | | | | | - Nick Curzen
- Southampton University Hospitals National Health Service Trust, Southampton, England
| | | | - Nina Cooter
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
| | | | - Nicola Skipper
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
| | - Derek Robinson
- Department of Mathematics, University of Sussex, East Sussex, England
| | - David Hildick-Smith
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
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Ghosh Dastidar A, Cengarle M, Mcalindon E, Augustine D, Vizzi V, Johnson T, Baumbach A, Strange J, Bucciarelli-Ducci C, Nightingale AK. Cost-effectiveness of non-invasive imaging guided strategy vs fractional flow reserve guided approach in patients with non-culprit lesion at primary percutaneous coronary intervention. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2933] [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: 11/14/2022] Open
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Ghosh Dastidar A, Cengarle M, Vizzi V, McAlindon E, Augustine D, Jenkins N, Johnson T, Strange J, Baumbach A, Bucciarelli-Ducci C, Nightingale A. 114 ROLE AND COST-EFFECTIVENESS OF NON-INVASIVE IMAGING GUIDED APPROACH IN PATIENTS WITH NON-CULPRIT CORONARY ARTERY LESION DIAGNOSED AT PRIMARY PERCUTANEOUS CORONARY INTERVENTION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.114] [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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De La Torre Hernandez JM, De Belder A, Palop RL, Hildick-Smith D, Hernandez F, O'Kane P, Gimeno F, Thomas M, Diaz JF, Curzen N, Saez PC, Strange J, Pinar E, Cotton J, Baz JA, Adamson D, Lozano I, Blackman D, Cuellas C, Skipper N, Cooter N, Diarte JA, Smith D, Mauri J. Everolimus-eluting vs. Bare Metal Stents in Octogenarians. Results from the Randomized XIMA (XIence or Vision Stent Management of Angina in the Elderly) Trial. Am J Cardiol 2013. [DOI: 10.1016/j.amjcard.2013.01.346] [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: 11/30/2022]
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McAlindon E, Johnson TW, Strange J, Lawton C, Baumbach A, Bucciarelli-Ducci C. Isolated anomalous right coronary artery from the pulmonary artery in adulthood: anatomical features and ischemic burden. Circulation 2012; 125:1183-5. [PMID: 22392866 DOI: 10.1161/circulationaha.111.049080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elisa McAlindon
- Bristol Heart Institute, National Institure for Health Research Biomedical Research Unit, Bristol, United Kingdom.
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McAlindon E, Strange J, Manghat N, Hamilton MCK, Wilde P, Drivas P, Pennell D, Bucciarelli-Ducci C. Prevalance of non-cardiac pathology on cardiovascular magnetic resonance studies. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106750 DOI: 10.1186/1532-429x-13-s1-p174] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Assomull RG, Shakespeare C, Kalra PR, Lloyd G, Gulati A, Strange J, Bradlow WM, Lyne J, Keegan J, Poole-Wilson P, Cowie MR, Pennell DJ, Prasad SK. Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology. Circulation 2011; 124:1351-60. [PMID: 21900085 DOI: 10.1161/circulationaha.110.011346] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [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: 12/16/2022]
Abstract
BACKGROUND In patients presenting with new-onset heart failure of uncertain etiology, the role of coronary angiography (CA) is unclear. Although conventionally performed to differentiate underlying coronary artery disease from dilated cardiomyopathy, CA is associated with a risk of complications and may not detect an ischemic cause resulting from arterial recanalization or an embolic episode. In this study, we assessed the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance CA as a noninvasive gatekeeper to CA in determining the etiology of heart failure in this subset of patients. METHODS AND RESULTS One hundred twenty consecutive patients underwent CMR and CA. The etiology was ascribed by a consensus panel that used the results of the CMR scans. Similarly, a separate consensus group ascribed an underlying cause by using the results of CA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all clinical data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when United Kingdom-based costs were assumed. The economic merits of this model would change, depending on the relative costs of LGE-CMR and CA in any specific healthcare system. CONCLUSION This study showed that LGE-CMR is a safe, clinically effective, and potentially economical gatekeeper to CA in patients presenting with heart failure of uncertain etiology.
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Affiliation(s)
- Ravi G Assomull
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
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