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De Silva K, Li Kam Wa ME, Wells T, Mozid A, Ladwiniec A, Hynes BG, Kotecha A, Ratib K, Biswas S, Amabile N, Deharo P, McEntagart M, Spratt JC, Digne F, Hogg M, Mailey JA, Walsh SJ, Kalra SS. The everolimus eluting Synergy Megatron TM drug-eluting stent platform: Early outcomes from the European Synergy Megatron TM Implanters' Registry. Catheter Cardiovasc Interv 2023; 102:1222-1228. [PMID: 37948428 PMCID: PMC10903108 DOI: 10.1002/ccd.30902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Synergy MegatronTM is an everolimus-drug eluting stent that may offer advantages in the treatment of aorto-ostial disease and large proximal vessels. AIMS To report the short- to medium-term clinical outcomes from the European Synergy MegatronTM Implanters' Registry. METHODS This registry was an investigator-initiated study conducted at 14 European centers. The primary outcome was target lesion failure (TLF), defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularisation. RESULTS Five hundred seventy-five patients underwent PCI with MegatronTM between 2019 and 2021. Patients were 69 ± 12 years old, 26% had diabetes mellitus, 24% had moderate-severe left ventricular impairment and 59% presented with an acute coronary syndrome. 15% were deemed prohibitively high risk for surgical revascularisation. The target vessel involved the left main stem in 55%, the ostium of the RCA in 13% and was a true bifurcation (Medina 1,1,1) in 50%. At 1 year, TLF was observed in 40 patients, with 26 (65%) occurring within the first 30 days. The cumulative incidence of TLF was 4.5% at 30 days and 8.6% (95% CI 6.3-11.7) at 1 year. The incidence of stent thrombosis was 0.5% with no late stent thromboses. By multivariate analysis, the strongest independent predictors of TLF were severe left ventricular impairment (HR 3.43, 95% CI: 1.67-6.76, p < 0.001) and a target vessel involving the left main (HR 4.00 95% CI 1.81-10.15 p = 0.001). CONCLUSIONS Use of the Synergy MegatronTM everolimus eluting stent in a 'real-world' setting shows favorable outcomes at 30 days and 1 year.
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Affiliation(s)
- Kalpa De Silva
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Matthew E. Li Kam Wa
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Tim Wells
- Cardiology Department, Salisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
| | - Abdul Mozid
- Cardio Respiratory Clinical Services Unit, Leeds General InfirmaryThe Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Andrew Ladwiniec
- Department of Cardiology, Glenfield HospitalUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Brian G. Hynes
- Cardiology DepartmentUniversity Hospital GalwayGalwayIreland
| | - Ashish Kotecha
- Department of Cardiology, Royal Devon and Exeter HospitalRoyal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Karim Ratib
- Cardiology Department, Royal Stoke University HospitalUniversity Hospitals of North Midlands NHS TrustStokeUK
| | - Sinjini Biswas
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Nicolas Amabile
- Cardiology DepartmentL'Institut Mutualiste MontsourisParisFrance
| | - Pierre Deharo
- Cardiology DepartmentAssistance Publique Hôpitaux de MarseilleMarseilleFrance
| | | | - James C. Spratt
- Cardiology Clinical Academic Group, St George's University HospitalSt George's University Hospitals NHS Foundation TrustLondonUK
| | - Franck Digne
- Cardiology DepartmentCentre Cardiologique du NordSaint DenisFrance
| | - Meadhbh Hogg
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | | | - Simon J. Walsh
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | - Sundeep S. Kalra
- Cardiology Department, Royal Free HospitalRoyal Free London NHS Foundation TrustLondonUK
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Bajaj R, Ramasamy A, Brown JT, Koganti S, Little C, Rathod KS, Jones DA, Rees P, Guttmann O, Lockie T, Ozkor M, Mathur A, Kalra SS, Baumbach A, Bourantas CV, Rakhit R, O'Mahony C. Treatment Strategies and Outcomes of Emergency Left Main Percutaneous Coronary Intervention. Am J Cardiol 2022; 177:1-6. [PMID: 35732552 DOI: 10.1016/j.amjcard.2022.04.043] [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] [Received: 11/24/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
Emergency percutaneous coronary intervention of the left main (LM ePCI) coronary artery necessitated by acute coronary syndrome is associated with a high risk of mortality. However, optimal treatment strategies and related outcomes remain undefined in this group. We undertook a multi-center, retrospective, observational cohort study of consecutive patients requiring LM ePCI between 2011 and 2018 and reported the coronary anatomy, treatment strategies, outcomes, and predictors of mortality. A total of 116 consecutive cases were included. Patients were predominantly male (85%) with a median age of 68.0 years; 12 patients (10%) had previous coronary artery bypass grafting. ST-elevation was noted in 76 (66%); 30 (26%) presented with an out-of-hospital cardiac arrest (OOHCA) and 47 (41%) with cardiogenic shock. The most frequent pattern of disease was Medina 1,1,1, seen in 59 patients (51%). The commonest revascularization strategy was provisional stenting (95 cases, 82%) with improved or thrombolysis in myocardial infarction 3 flow seen in 85 cases (73%). All-cause mortality was 35% at 30 days, rising to 58% at 5 years. Adverse predictors of 30-day mortality included presentation with cardiogenic shock (p = 0.018) and OOHCA (p = 0.020), whereas improved flow and/or thrombolysis in myocardial infarction 3 flow in both circumflex and left anterior descending artery afforded a better prognosis (p = 0.028). In conclusion, patients who underwent LM ePCI are a high-risk subgroup and commonly present with cardiogenic shock and OOHCA. Provisional stenting appears to be the preferred option with the successful restoration of coronary flow in most cases despite complex anatomy. High 30-day mortality is driven by the presence of cardiogenic shock, OOHCA, and failure to restore or improve coronary flow.
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Affiliation(s)
- Retesh Bajaj
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - James T Brown
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; National Pulmonary Hypertension Service; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Sudheer Koganti
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom; Citizens Specialty Hospital, Hyderabad, India
| | - Callum Little
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Paul Rees
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Oliver Guttmann
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Tim Lockie
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Mick Ozkor
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Sundeep S Kalra
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Queen Mary University London, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Constantinos O'Mahony
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
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Kalra SS, Chizinga M, Ataya A. The 'hot nose' sign in brain death. QJM 2020; 113:365-366. [PMID: 31504902 DOI: 10.1093/qjmed/hcz223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S S Kalra
- Division of Pulmonary, Critical Care, and Sleep Medicine Ethics, University of Florida, Gainesville, FL 32608, USA
| | - M Chizinga
- Division of Pulmonary, Critical Care, and Sleep Medicine Ethics, University of Florida, Gainesville, FL 32608, USA
| | - A Ataya
- Division of Pulmonary, Critical Care, and Sleep Medicine Ethics, University of Florida, Gainesville, FL 32608, USA
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Kalra SS, Innabi A, Runnstrom M, Lascano J, Patel DC. Response to: Severe hypertriglyceridemia, acute pancreatitis and chyloptysis. QJM 2020; 113:300-301. [PMID: 31633758 DOI: 10.1093/qjmed/hcz269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S S Kalra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
| | - A Innabi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
| | - M Runnstrom
- Division of Internal Medicine, Department of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - J Lascano
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
| | - D C Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
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Affiliation(s)
- M Runnstrom
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - S S Kalra
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - J Lascano
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - D C Patel
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
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Kalra SS, Innabi A, Runnstrom M, Lascano J, Patel DC. Severe hypertriglyceridemia, acute pancreatitis and chyloptysis. QJM 2020; 113:47-48. [PMID: 31529077 DOI: 10.1093/qjmed/hcz236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- S S Kalra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - A Innabi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - M Runnstrom
- Division of Internal Medicine, Department of Medicine, Emory University, Atlanta, GA, USA
| | - J Lascano
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - D C Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
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Rathod KS, Koganti S, Iqbal MB, Jain AK, Kalra SS, Astroulakis Z, Lim P, Rakhit R, Dalby MC, Lockie T, Malik IS, Knight CJ, Whitbread M, Mathur A, Redwood S, MacCarthy PA, Sirker A, O’Mahony C, Wragg A, Jones DA. Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group. European Heart Journal: Acute Cardiovascular Care 2017; 7:16-27. [DOI: 10.1177/2048872617741735] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Cardiogenic shock remains a major cause of morbidity and mortality in patients with ST-segment elevation myocardial infarction. We aimed to assess the current trends in cardiogenic shock management, looking specifically at the incidence, use of intra-aortic balloon pump therapy and outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Methods and results: We undertook an observational cohort study of 21,210 ST-segment elevation myocardial infarction patients treated between 2005–2015 at the eight Heart Attack Centres in London, UK. Patients’ details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society percutaneous coronary intervention dataset. There were 1890 patients who presented with cardiogenic shock. The primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2–5.8 years). Increasing rates of cardiogenic shock were seen over the course of the study with consistently high mortality rates of 45–70%. A total of 685 patients underwent intra-aortic balloon pump insertion during primary percutaneous coronary intervention for cardiogenic shock with decreasing rates over time. Those patients undergoing intra-aortic balloon pump therapy were younger, more likely to have poor left ventricular function and less likely to have had previous percutaneous coronary intervention compared to the control group. Procedural success rates were similar (86.0% vs 87.1%, p=0.292) although crude, in-hospital major adverse cardiac event rates were higher (43.8% vs 33.7%, p<0.0001) in patients undergoing intra-aortic balloon pump therapy. Kaplan-Meier analysis demonstrated significantly higher mortality rates in patients receiving intra-aortic balloon pump therapy (50.9% intra-aortic balloon pump vs 39.9% control, p<0.0001) during the follow-up period. After multivariate Cox analysis (hazard ratio 1.04, 95% confidence interval 0.62–1.89) and the use of propensity matching (hazard ratio: 1.29, 95% confidence interval: 0.68–1.45) intra-aortic balloon pump therapy was not associated with mortality. Conclusion: Cardiogenic shock treated by percutaneous coronary intervention is increasing in incidence and remains a condition associated with high mortality and limited treatment options. Intra-aortic balloon pump therapy was not associated with a long-term survival benefit in this cohort and may be associated with increased early morbidity.
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Affiliation(s)
| | | | - M Bilal Iqbal
- Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, UK
| | | | - Sundeep S Kalra
- Kings College Hospital, King’s College Hospital NHS Foundation Trust, UK
| | - Zoe Astroulakis
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, UK
| | - Pitt Lim
- St George’s Healthcare NHS Foundation Trust, St George’s Hospital, UK
| | | | - Miles C Dalby
- Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, UK
| | - Tim Lockie
- Royal Free London NHS Foundation Trust, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, UK
| | | | | | | | - Simon Redwood
- St Thomas’ NHS Foundation Trust, Guys and St Thomas Hospital, UK
| | - Philip A MacCarthy
- Kings College Hospital, King’s College Hospital NHS Foundation Trust, UK
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Kalra SS, Firoozi S, Yeh J, Blackman DJ, Rashid S, Davies S, Moat N, Dalby M, Kabir T, Khogali SS, Anderson RA, Groves PH, Mylotte D, Hildick-Smith D, Rampat R, Kovac J, Gunarathne A, Laborde JC, Brecker SJ. Initial Experience of a Second-Generation Self-Expanding Transcatheter Aortic Valve: The UK & Ireland Evolut R Implanters' Registry. JACC Cardiovasc Interv 2017; 10:276-282. [PMID: 28183467 DOI: 10.1016/j.jcin.2016.11.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/24/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The authors present the UK and Irish real-world learning curve experience of the Evolut R transcatheter heart valve. BACKGROUND The Evolut R is a self-expanding, repositionable, and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcomes and reduce complications. METHODS Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive the Evolut R valve in the United Kingdom and Ireland. RESULTS A total of 264 consecutive Evolut R implantations were performed across 9 centers. The mean age was 81.1 ± 7.8 years, and the mean logistic European System for Cardiac Operative Risk Evaluation score was 19.9 ± 13.7%. Procedural indications included aortic stenosis (72.0%), mixed aortic valve disease (17.4%), and failing aortic valve bioprostheses (10.6%). Conscious sedation was used in 39.8% of patients and transfemoral access in 93.6%. The procedural success rate was 91.3%, and paravalvular leak immediately after implantation was mild or less in 92.3%. Major complications were rare: cardiac tamponade in 0.4%, conversion to sternotomy in 0.8%, annular rupture in 0.0%, coronary occlusion in 0.8%, major vascular in 5.3%, acute kidney injury in 6.1%, new permanent pacemaker implantation in 14.7%, and procedure-related death in 0.0%. At 30-day follow-up, survival was 97.7%, paravalvular leak was mild or less in 92.3%, and the stroke rate was 3.8%. CONCLUSIONS This registry represents the largest published real-world experience of the Evolut R valve. The procedural success rate was high and safety was excellent, comparable with previous studies of the Evolut R valve and other second-generation devices. The low rate of complications represents an improvement on first-generation devices.
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Affiliation(s)
- Sundeep S Kalra
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - James Yeh
- Cardiology Department, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Daniel J Blackman
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Shabnam Rashid
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Simon Davies
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Neil Moat
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Miles Dalby
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Tito Kabir
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Saib S Khogali
- Cardiology Department, The Royal Wolverhampton Hospitals, Wolverhampton, United Kingdom
| | - Richard A Anderson
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter H Groves
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Darren Mylotte
- Cardiology Department, University Hospital Galway, Galway, Ireland
| | - David Hildick-Smith
- Cardiology Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Rajiv Rampat
- Cardiology Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Jan Kovac
- Cardiology Department, Glenfield Hospital, Leicester, United Kingdom
| | - Ashan Gunarathne
- Cardiology Department, Glenfield Hospital, Leicester, United Kingdom
| | - Jean-Claude Laborde
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom.
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Bromage DI, Jones DA, Rathod KS, Grout C, Iqbal MB, Lim P, Jain A, Kalra SS, Crake T, Astroulakis Z, Ozkor M, Rakhit RD, Knight CJ, Dalby MC, Malik IS, Mathur A, Redwood S, MacCarthy PA, Wragg A. Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc 2016; 5:JAHA.115.003027. [PMID: 27353606 PMCID: PMC4937253 DOI: 10.1161/jaha.115.003027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background ST‐segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Methods and Results We analyzed 10 249 consecutive patients with ST‐segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all‐cause mortality at a median follow‐up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In‐hospital mortality (7.7% vs 2.4%, P<0.0001) and long‐term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07–1.09, P<0.0001). Time‐stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long‐term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts. Conclusions In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in‐hospital outcomes were reasonable, and long‐term mortality rates were static.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Daniel A Jones
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | - Claire Grout
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - M Bilal Iqbal
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Pitt Lim
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ajay Jain
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Sundeep S Kalra
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Crake
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | - Zoe Astroulakis
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mick Ozkor
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | | | | | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Simon Redwood
- BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Wragg
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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Kalra SS, Firoozi S, Laborde JC, Brecker SJ. Transcatheter Aortic Valve Replacement in a Patient With a Single Coronary Artery: Use of a Recapturable System. J Interv Cardiol 2016; 29:124. [DOI: 10.1111/joic.12252] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sundeep S. Kalra
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
| | - Sami Firoozi
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
| | - Jean-Claude Laborde
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
| | - Stephen J. Brecker
- Department of Cardiology; St. George's University Hospital, London SW17 0QT; United Kingdom
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Iqbal MB, Ilsley CD, Mikhail G, Khamis R, Archbold A, Crake T, Firoozi S, Kalra SS, Knight C, Lim P, Mathur A, Meier P, Rakhit R, Redwood S, Whitbread M, Bromage D, Rathod K, Wragg A, MacCarthy PA, Dalby MC, Malik IS. TCT-28 Comparison Of Outcomes For Primary Percutaneous Coronary Intervention During Out Of Working Hours Versus In Working Hours: An Observational Cohort Study Of 11,461 Patients. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Iqbal MB, Hadjiloizou N, Kabir T, Archbold A, Crake T, Firoozi S, Kalra SS, Knight C, Lim P, Malik IS, Mathur A, Meier P, Rakhit R, Redwood S, Whitbread M, Rathod K, Bromage D, Wragg A, MacCarthy PA, Dalby MC. TCT-241 Drug-Eluting Stents Are Superior To Bare Metal Stents In Reducing Mortality In Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Iqbal MB, Arujuna A, Archbold A, Crake T, Firoozi S, Kalra SS, Knight C, Lim P, Malik IS, Mathur A, Meier P, Rakhit R, Redwood S, Whitbread M, Bromage D, Rathod K, Wragg A, MacCarthy PA, Dalby MC. TCT-42 Superior Outcomes Associated With Radial Versus Femoral Access In Non-ST Elevation Myocardial Infarction: An Observational Cohort Study of 10,095 patients. Results Of The Radial Versus Femoral Access In Mortality Reduction In Non-ST Elevation Myocardial Infarction (REALITY-NSTEMI) Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.773] [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: 10/26/2022]
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Abstract
Vascular calcification is an active and regulated process which is integral to cardiovascular disease and intimately linked to hypertension. Dysfunctional vascular smooth muscle cells, microvesicles, and dysregulated mineralization inhibitors play key roles in the calcification process, which occurs in the vessel intima in association with atherosclerosis as well as in the vessel media during ageing. Historically hypertension was considered a risk factor promoting atherosclerosis and associated intimal calcification. However, it is now recognized that not all vascular calcification occurs with atherosclerosis, and calcification of the vessel media is associated with arterial stiffening and is a major cause of isolated systolic hypertension in the elderly. Importantly, vascular calcification, regardless of its anatomical site, is an independent risk factor for cardiovascular mortality. Therefore, understanding the factors and mechanisms driving these processes will provide novel therapeutic targets for its prevention and perhaps ultimately its regression.
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Affiliation(s)
- Sundeep S Kalra
- BHF Centre of Research Excellence, Cardiovascular Division, King's College London, UK
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