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McCarthy CP, Wasfy JH, Januzzi JL. Is Myocardial Infarction Overdiagnosed? JAMA 2024; 331:1623-1624. [PMID: 38656331 DOI: 10.1001/jama.2024.5235] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
This Viewpoint examines whether overdiagnosis rather than underdiagnosis may now be the dominant form of myocardial infarction misdiagnosis.
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jason H Wasfy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston
- Baim Institute for Clinical Research, Boston, Massachusetts
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2
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Sultana S, McCarthy CP, Randhawa M, Cao J, Parakh A, Baliyan V. Role of Computed Tomography in Cardiac Electrophysiology. Radiol Clin North Am 2024; 62:489-508. [PMID: 38553182 PMCID: PMC11088717 DOI: 10.1016/j.rcl.2023.12.016] [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] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
With the increasing prevalence of arrhythmias, the use of electrophysiology (EP) procedures has increased. Recent advancements in computed tomography (CT) technology have expanded its use in pre-assessments and post-assessments of EP procedures. CT provides high-resolution images, is noninvasive, and is widely available. This article highlights the strengths and weaknesses of cardiac CT in EP.
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Affiliation(s)
- Sadia Sultana
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mangun Randhawa
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jinjin Cao
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Anushri Parakh
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Vinit Baliyan
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Pareek M, Kristensen AMD, Vaduganathan M, Byrne C, Biering-Sørensen T, Lassen MCH, Johansen ND, Skaarup KG, Rosberg V, Pallisgaard JL, Mortensen MB, Maeng M, Polcwiartek CB, Frangeskos J, McCarthy CP, Bonde AN, Lee CJY, Fosbøl EL, Køber L, Olsen NT, Gislason GH, Torp-Pedersen C, Bhatt DL, Kragholm KH. Serial troponin-I and long-term outcomes in subjects with suspected acute coronary syndrome. Eur J Prev Cardiol 2024; 31:615-626. [PMID: 38057157 PMCID: PMC11109926 DOI: 10.1093/eurjpc/zwad373] [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: 07/18/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
AIMS It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS). METHODS AND RESULTS Subjects who underwent two hsTnI measurements (Siemens TnI Flex® Reagent) separated by 1-7 h, during a first-time hospitalization for myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019, were identified through Danish national registries. Individuals were stratified per their hsTnI concentration pattern (normal, rising, persistently elevated, or falling) and the magnitude of hsTnI concentration change (<20%, >20-50%, or >50% in either direction). We calculated absolute and relative mortality risks standardized to the distributions of risk factors for the entire study population. A total of 20 609 individuals were included of whom 2.3% had died at 30 days, and an additional 4.7% had died at 365 days. The standardized risk of death was highest among persons with a persistently elevated hsTnI concentration (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal hsTnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative hsTnI concentration changes between measurements clearly affect mortality risk. Among persons with a rising hsTnI concentration pattern, 30-day mortality was higher in subjects with a >50% rise compared with those with a less pronounced rise (2.2% vs. <0.1%). CONCLUSION Among individuals with suspected ACS, those with a persistently elevated hsTnI concentration consistently had the highest risk of death. In subjects with two normal hsTnI concentrations, mortality was very low and not affected by the magnitude of change between measurements.
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Affiliation(s)
- Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | | | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Christina Byrne
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Mats Christian Højbjerg Lassen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Niklas Dyrby Johansen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Kristoffer Grundtvig Skaarup
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Victoria Rosberg
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jannik L. Pallisgaard
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | - Julia Frangeskos
- Department of Cardiology, Peconic Bay Medical Center at Northwell Health, Riverhead, NY, USA
| | - Cian P. McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anders Nissen Bonde
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Emil L. Fosbøl
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Gunnar H. Gislason
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital – North Zealand Hospital, Hillerød, Denmark
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wasfy JH, Price M, Normand SLT, Januzzi JL, McCarthy CP, Hsu J. Classification Algorithm to Distinguish Between Type 1 and Type 2 Myocardial Infarction in Administrative Claims Data. Circ Cardiovasc Qual Outcomes 2024; 17:e009986. [PMID: 38240159 PMCID: PMC11087697 DOI: 10.1161/circoutcomes.123.009986] [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: 02/13/2023] [Accepted: 10/25/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) and type 1 myocardial infarction (T1MI) differ with respect to demographics, comorbidities, treatments, and clinical outcomes. Reliable quality and outcomes assessment depends on the ability to distinguish between T1MI and T2MI in administrative claims data. As such, we aimed to develop a classification algorithm to distinguish between T1MI and T2MI that could be applied to claims data. METHODS Using data for beneficiaries in a Medicare accountable care organization contract in a large health care system in New England, we examined the distribution of MI diagnosis codes between 2018 to 2021 and the patterns of care and coding for beneficiaries with a hospital discharge diagnosis International Classification of Diseases, Tenth Revision code for T2MI, compared with those for T1MI. We then assessed the probability that each hospitalization was for a T2MI versus T1MI and examined care occurring in 2017 before the introduction of the T2MI code. RESULTS After application of inclusion and exclusion criteria, 7759 hospitalizations for myocardial infarction remained (46.5% T1MI and 53.5% T2MI; mean age, 79±10.3 years; 47% female). In the classification algorithm, female gender (odds ratio, 1.26 [95% CI, 1.11-1.44]), Black race relative to White race (odds ratio, 2.48 [95% CI, 1.76-3.48]), and diagnoses of COVID-19 (odds ratio, 1.74 [95% CI, 1.11-2.71]) or hypertensive emergency (odds ratio, 1.46 [95% CI, 1.00-2.14]) were associated with higher odds of the hospitalization being for T2MI versus T1MI. When applied to the testing sample, the C-statistic of the full model was 0.83. Comparison of classified T2MI and observed T2MI suggest the possibility of substantial misclassification both before and after the T2MI code. CONCLUSIONS A simple classification algorithm appears to be able to differentiate between hospitalizations for T1MI and T2MI before and after the T2MI code was introduced. This could facilitate more accurate longitudinal assessments of acute myocardial infarction quality and outcomes.
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Affiliation(s)
- Jason H. Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mary Price
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sharon-Lise T. Normand
- Department of Health Care Policy, Harvard Medical School, and the Department of Biostatistics, Harvard Chan School of Public Health, Boston, MA
| | - James L. Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Cian P. McCarthy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John Hsu
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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McCarthy CP, Murphy SP, Amponsah DK, Rambarat PK, Lin C, Liu Y, Mohebi R, Levin A, Raghavan A, Miksenas H, Rogers C, Wasfy JH, Blankstein R, Ghoshhajra B, Hedgire S, Januzzi JL. Coronary Computed Tomographic Angiography With Fractional Flow Reserve in Patients With Type 2 Myocardial Infarction. J Am Coll Cardiol 2023; 82:1676-1687. [PMID: 37777947 DOI: 10.1016/j.jacc.2023.08.020] [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: 06/01/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) related to a supply/demand imbalance of coronary blood flow is common and associated with poor prognosis. Coronary artery disease (CAD) may predispose some individuals to T2MI and contribute to its high rate of recurrent cardiovascular events. Little is known about the presence and extent of CAD in this population. OBJECTIVES The goal of this study was to evaluate the presence and characteristics of CAD among patients with T2MI. METHODS In this prospective study, consecutive eligible individuals with Fourth Universal Definition of Myocardial Infarction criteria for T2MI were enrolled. Participants underwent coronary computed tomography angiography (CTA), fractional flow reserve derived with coronary CTA (FFRCT), and plaque volume analyses. RESULTS Among 50 participants, 25 (50%) were female, and the mean age was 68.0 ± 11.4 years. Atherosclerotic risk factors were common. Coronary CTA revealed coronary plaque in 46 participants (92%). A moderate or greater stenosis (≥50%) was identified in 42% of participants, and obstructive disease (≥50% left main stenosis or ≥70% stenosis in any other epicardial coronary artery) was present in 26%. Prevalence of obstructive CAD did not differ according to T2MI cause (P = 0.54). A hemodynamically significant focal stenosis identified by FFRCT was present in 13 participants (26%). Among participants with a stenosis ≥50% (n = 21), FFRCT excluded lesion-specific hemodynamically significant stenosis in 8 cases (38%). CONCLUSIONS Among individuals with adjudicated T2MI, CAD was prevalent, but the majority of patients had nonobstructive CAD. Mediators of ischemia are likely multifactorial in this population. (Defining the Prevalence and Characteristics of Coronary Artery Disease Among Patients with Type 2 Myocardial Infarction using CT-FFR [DEFINE TYPE 2 MI]; NCT04864119).
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/CianPMcCarthy
| | - Sean P Murphy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel K Amponsah
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paula K Rambarat
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Lin
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuxi Liu
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Reza Mohebi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison Levin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avanthi Raghavan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Miksenas
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ron Blankstein
- Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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Atallah J, Chiha T, Chen C, Siller-Matula JM, McCarthy CP, Januzzi JL, Wasfy JH. Clinical outcomes associated with type II myocardial infarction caused by bleeding. Am Heart J 2023; 263:85-92. [PMID: 37201860 DOI: 10.1016/j.ahj.2023.05.008] [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: 11/30/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Type ll myocardial infarction (T2MI) is caused by a mismatch between myocardial oxygen supply and demand. One subset of individuals is T2MI caused by acute hemorrhage. Traditional MI treatments including antiplatelets, anticoagulants, and revascularization can worsen bleeding. We aim to report outcomes of T2MI patients due to bleeding, stratified by treatment approach. METHODS The MGB Research Patient Data Registry followed by manual physician adjudication was used to identify individuals with T2MI caused by bleeding between 2009 and 2022. We defined 3 treatment groups: (1) invasively managed, (2) pharmacologic, and (3) conservatively managed Clinical parameters and outcomes for 30-day, mortality, rebleeding, and readmission were abstracted compared between the treatment groups. RESULTS We identified 5,712 individuals coded with acute bleeding, of which 1,017 were coded with T2MI during their admission. After manual physician adjudication, 73 individuals met the criteria for T2MI caused by bleeding. 18 patients were managed invasively, 39 received pharmacologic therapy alone, and 16 were managed conservatively. The invasively managed group experienced lower mortality (P = .021) yet higher readmission (P = .045) than the conservatively managed group. The pharmacologic group also experienced lower mortality (P= .017) yet higher readmission (P = .005) than the conservatively managed group. CONCLUSION Individuals with T2MI associated with acute hemorrhage are a high-risk population. Patients treated with standard procedures experienced higher readmission but lower mortality than conservatively managed patients. These results raise the possibility of testing ischemia-reduction approaches for such high-risk populations. Future clinical trials are required to validate treatment strategies for T2MI caused by bleeding.
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Affiliation(s)
- Johnny Atallah
- Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Tania Chiha
- Harvard Medical School, Boston, MA; Pulmonology and Critical Care Division, Brigham and Women's Hospital, MA
| | - Chen Chen
- Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital, Boston, MA
| | | | - Cian P McCarthy
- Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - James L Januzzi
- Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital, Boston, MA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA
| | - Jason H Wasfy
- Harvard Medical School, Boston, MA; Cardiology Division, Massachusetts General Hospital, Boston, MA.
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Adusumalli S, Mohebi R, McCarthy CP, Megaret CA, Rhyne RF, Jaffer FA, Januzzi JL. Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions. medRxiv 2023:2023.07.19.23292911. [PMID: 37503157 PMCID: PMC10371101 DOI: 10.1101/2023.07.19.23292911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). Objectives We evaluated performance of a blood biomarker panel to predict cardiovascular (CV) events in patients with CTO. Methods From 1251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, non-fatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization. Results of a biomarker panel (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) from baseline samples were expressed as low-, moderate-, and high-risk. Results By 4 years, a total of 67 (27.8%) MACE events and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79. Considering patients in the low-risk group as a reference, the hazard ratio of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98-14.8) and 12.4 (95% CI:5.17-29.6) for the moderate and high-risk groups (both P <0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84. Compared to the low-risk score group, the moderate and high-risk groups had hazard ratios of 5.61 (95% CI: 2.33-13.5) and 15.6 (95% CI: 6.18, 39.2; both P value <0.001). Conclusion A multiple biomarker panel assists in evaluating the risk of adverse outcomes in patients with coronary CTO. These results may have implications for patient care and could have a role for clinical trial enrichment. Clinical Trial CASABLANCA, ClinicalTrials.gov Identifier: NCT00842868.
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McCarthy CP, Vyas A, Januzzi JL. What Is a Normal Troponin, Anyway? J Am Coll Cardiol 2023; 81:2040-2042. [PMID: 37197847 DOI: 10.1016/j.jacc.2023.03.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Austin Vyas
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA. https://twitter.com/JJheart_doc
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McCarthy CP, Murphy SP, Miksenas H, Amponsah D, Rambarat P, Levin A, Raghavan A, Mohebi R, Lin C, Rogers CD, Wasfy JH, Blankstein R, Ghoshhajra BB, Hedgire S, Januzzi JL. DEFINING THE PREVALENCE AND CHARACTERISTICS OF CORONARY ARTERY DISEASE AMONG PATIENTS WITH TYPE 2 MYOCARDIAL INFARCTION USING CT-FFR (DEFINE TYPE 2 MI). J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01568-1] [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: 03/06/2023]
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McCarthy CP, Natarajan P. Systolic Blood Pressure and Cardiovascular Risk: Straightening the Evidence. Hypertension 2023; 80:577-579. [PMID: 36791225 PMCID: PMC9942105 DOI: 10.1161/hypertensionaha.123.20788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (C.P.M., P.N.)
| | - Pradeep Natarajan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (C.P.M., P.N.)
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (P.N.)
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Mohebi R, van Kimmenade R, McCarthy CP, Magaret CA, Barnes G, Rhyne RF, Gaggin HK, Januzzi JL. Performance of a multi-biomarker panel for prediction of cardiovascular event in patients with chronic kidney disease. Int J Cardiol 2023; 371:402-405. [PMID: 36202172 PMCID: PMC9977515 DOI: 10.1016/j.ijcard.2022.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) undergoing coronary catheterization are at increased risk of cardiovascular events (CVE). Measuring biomarkers before the procedure may guide clinicians in identifying patients at higher risk of future cardiovascular events. METHODS In this sub-study the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA), 927 patients underwent coronary catheterization and were followed up for two years. Using machine learning algorithm and targeted proteomics from samples of patients with CKD, 4 biomarkers (kidney injury molecule-1, N-terminal pro B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) were integrated into a prognostic algorithm to predict CVE. Results from the panel are expressed in a graded fashion (CVE higher risk and lower risk) using a data-driven cutoff optimized for balanced sensitivity and specificity. RESULTS During the 2-year follow-up, 74 CVE were ascertained. 51 (rate: 51/378 = 13.5%) events occurred in stage 1-2 CKD and 23 (rate: 23/68 = 33.8%) events occurred in stage 3-5 CKD. The C-statistic for predicting 2-years cardiovascular events in all 446 patients was 0.77 (0.72, 0.82). The model was well-calibrated (Hosmer-Lemeshow test p-value >0.40). Considering patients at CVE lower-risk within each CKD staging group as a reference, the hazard ratio (95% confidence interval) of cardiovascular events was 2.82 (1.53, 5.22) for CKD stage 1-2/CVE higher-risk, and 8.32 (1.12, 61.76) for CKD stage 3-5/CVE higher-risk. CONCLUSION Measuring biomarker panel prior to coronary catheterization may be useful to individualize CVE risk assessment among patients with CKD.
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Affiliation(s)
- Reza Mohebi
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | | | - Cian P McCarthy
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | | | - Grady Barnes
- Prevencio, Inc., Kirkland, WA, United States of America
| | | | - Hanna K Gaggin
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - James L Januzzi
- Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Baim Institute for Clinical Research, Boston, MA, United States of America.
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Kontos MC, de Lemos JA, Deitelzweig SB, Diercks DB, Gore MO, Hess EP, McCarthy CP, McCord JK, Musey PI, Villines TC, Wright LJ. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022; 80:1925-1960. [PMID: 36241466 PMCID: PMC10691881 DOI: 10.1016/j.jacc.2022.08.750] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Levine GN, McEvoy JW, Fang JC, Ibeh C, McCarthy CP, Misra A, Shah ZI, Shenoy C, Spinler SA, Vallurupalli S, Lip GYH. Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e205-e223. [PMID: 36106537 DOI: 10.1161/cir.0000000000001092] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.
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Mohebi R, McCarthy CP, Gaggin HK, van Kimmenade RRJ, Januzzi JL. Inflammatory biomarkers and risk of cardiovascular events in patients undergoing coronary angiography. Am Heart J 2022; 252:51-59. [PMID: 35753356 PMCID: PMC9336200 DOI: 10.1016/j.ahj.2022.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Inflammation, measured by traditional biomarkers such as C-reactive protein, has been linked to cardiovascular (CV) events. Recent technological advancement has allowed for measuring larger numbers of inflammatory biomarkers. A contemporary evaluation with established and novel biomarkers of inflammation is needed. METHODS 1,090 individuals who underwent coronary angiography were enrolled. Twenty-four inflammatory biomarkers were collected prior to angiography. Unsupervised machine learning cluster analyses determined unique patterns of inflammatory biomarkers. Cox proportional hazard regression assessed both association of inflammatory biomarker clusters and individual biomarker associations with major adverse cardiovascular events (MACE; non-fatal myocardial infarction or stroke, and CV death) during a median follow-up of 3.67 years. RESULTS Four distinct clusters were recognized. Incremental increases in inflammatory biomarkers were observed from cluster 1 to cluster 4. During follow-up, 263 MACE were ascertained. Considering cluster 1 as a reference, study participants with inflammatory cluster 2 (Hazard ratio [HR] 1.55, 95% confidence interval [CI]: 1.01-2.37), cluster 3 (HR 1.89, CI: 1.25-2.85), and cluster 4 (HR 2.93, CI: 1.95-4.42) were at increased risk of MACE. Interleukin (IL)-1α IL-6, IL-8, IL-10, IL-12, Adhesion molecule-1 high-sensitivity C-reactive protein, ferritin, myeloperoxidase, macrophage inflammatory protein (MIP)-1a, MIP 3, and macrophage colony-stimulating factor-1 were independently associated with MACE. CONCLUSIONS Among persons undergoing coronary angiography procedures, distinct clusters of inflammatory biomarker distributions with significant prognostic meaning may be identified. These results may identify unique targets for anti-inflammatory treatments aimed at CV disease.
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Affiliation(s)
- Reza Mohebi
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Cian P McCarthy
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Hanna K Gaggin
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - James L Januzzi
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Baim Institute for Clinical Research, Boston, MA.
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Mohebi R, Chen C, Ibrahim NE, McCarthy CP, Gaggin HK, Singer DE, Hyle EP, Wasfy JH, Januzzi JL. Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates. J Am Coll Cardiol 2022; 80:565-578. [PMID: 35926929 DOI: 10.1016/j.jacc.2022.05.033] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [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: 04/11/2022] [Accepted: 05/04/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Understanding trends in cardiovascular (CV) risk factors and CV disease according to age, sex, race, and ethnicity is important for policy planning and public health interventions. OBJECTIVES The goal of this study was to project the number of people with CV risk factors and disease and further explore sex, race, and ethnical disparities. METHODS The prevalence of CV risk factors (diabetes mellitus, hypertension, dyslipidemia, and obesity) and CV disease (ischemic heart disease, heart failure, myocardial infarction, and stroke) according to age, sex, race, and ethnicity was estimated by using logistic regression models based on 2013-2018 National Health and Nutrition Examination Survey data and further combining them with 2020 U.S. Census projection counts for years 2025-2060. RESULTS By the year 2060, compared with the year 2025, the number of people with diabetes mellitus will increase by 39.3% (39.2 million [M] to 54.6M), hypertension by 27.2% (127.8M to 162.5M), dyslipidemia by 27.5% (98.6M to 125.7M), and obesity by 18.3% (106.3M to 125.7M). Concurrently, projected prevalence will similarly increase compared with 2025 for ischemic heart disease by 31.1% (21.9M to 28.7M), heart failure by 33.0% (9.7M to 12.9M), myocardial infarction by 30.1% (12.3M to 16.0M), and stroke by 34.3% (10.8M to 14.5M). Among White individuals, the prevalence of CV risk factors and disease is projected to decrease, whereas significant increases are projected in racial and ethnic minorities. CONCLUSIONS Large future increases in CV risk factors and CV disease prevalence are projected, disproportionately affecting racial and ethnic minorities. Future health policies and public health efforts should take these results into account to provide quality, affordable, and accessible health care.
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Affiliation(s)
- Reza Mohebi
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Chen Chen
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | | | - Cian P McCarthy
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Hanna K Gaggin
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel E Singer
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emily P Hyle
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Jason H Wasfy
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - James L Januzzi
- Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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16
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Mohebi R, McCarthy CP, Magaret CA, Barnes G, Rhyne RF, Peters C, Gaggin HK, Januzzi JL. Performance of a protein biomarker panel for prediction of cardiovascular events in patients with diabetes mellitus. Eur J Prev Cardiol 2022; 29:e270-e271. [PMID: 35258630 PMCID: PMC10039396 DOI: 10.1093/eurjpc/zwac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Reza Mohebi
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Cian P. McCarthy
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | | | | | - Hanna K. Gaggin
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - James L. Januzzi
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Baim Institute for Clinical Research, Boston, MA
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McCarthy CP, Januzzi JL. Multiple biomarkers for rapid rule-out of myocardial infarction: worth the added stress? Eur Heart J Acute Cardiovasc Care 2022; 11:213-214. [PMID: 35146506 DOI: 10.1093/ehjacc/zuac019] [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] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 32 Fruit Street, Yawkey 5B, Boston, MA 02114, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 32 Fruit Street, Yawkey 5B, Boston, MA 02114, USA.,Baim Institute for Clinical Research, Boston, MA, USA
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18
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Mohebi R, McCarthy CP, Magaret CA, Barnes G, Rhyne R, Peters C, Gaggin HK, Januzzi JL. PERFORMANCE OF A MULTIPLE PROTEIN BIOMARKER PANEL FOR PREDICTION OF CARDIOVASCUALR EVENTS IN PATIENTS WITH DIABETES MELLITUS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mohebi R, Chen C, McCarthy CP, Gaggin HK, Singer DE, Hyle EP, Wasfy JH, Januzzi JL. FORECASTING TRENDS IN CARDIOMETABOLIC RISK FACTORS IN THE UNITED STATES: ESTIMATES BASED ON THE 2020 CENSUS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02498-6] [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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20
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA. https://twitter.com/JJheart_doc
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21
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Neumann JT, Sorenson NA, McCarthy CP, Magaret CA, Rhyne RF, Peters CC, Barnes G, Defilippi CR, Westermann D, Januzzi JL. A pooled multi-national validation study of a machine learning, high-sensitivity troponin-based multi-proteomic model to predict the presence of obstructive coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1374] [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
Undetected obstructive coronary artery disease (oCAD) is a global health problem associated with significant morbidity and mortality. A need exists for an accurate and easily accessible diagnostic test for oCAD. Using machine learning, a multi-biomarker blood diagnostic test for oCAD based on high-sensitivity cardiac troponin-I (hs-cTnI) has been developed.
Purpose
To validate the performance of a previously developed, algorithmically weighted, multiple protein diagnostic panel to diagnose oCAD in a pooled multi-national cohort and to compare the diagnostic panel's performance to predict oCAD to hs-cTnI alone.
Methods
Three clinical factors (sex, age, and previous coronary percutaneous intervention) and three biomarkers (hs-cTnI, Adiponectin, and Kidney Injury Molecule-1) were combined. hs-cTnI blood samples were assayed on the Siemens Atellica and Abbott Diagnostics ARCHITECT immunoassay platforms. Adiponectin and Kidney Injury Molecule-1 were measured with a multiplex assay on blood samples via the Luminex 100/200 xMAP platform. Individual data from a total of 924 patients with a mixture of acute and lesser acute presentations from three centers were pooled (Table 1). oCAD was defined as >50% coronary obstruction in at least one coronary artery (for the University Hospital Hamburg-Eppendorf cohort) or >70% coronary obstruction in at least one coronary artery (for the other two cohorts). The multiple biomarker diagnostic panel's performance to predict oCAD was also compared to hs-cTnI alone.
Results
The multiple protein panel had an area under the receiver-operating characteristic curve of 0.80 (95% CI, 0.77, 0.83, p<0.001) for the presence of oCAD (Figure 1). At optimal cutoff, the score had 74% sensitivity, 72% specificity, and a positive predictive value of 81% for oCAD. The multiple biomarker panel had a diagnostic odds ratio of 7.48 (95% CI 5.55, 10.09, p<0.001). In comparison, in patients without an acute MI, hs-cTnI alone had an area under the receiver-operating characteristic curve of 0.63 (95% CI, 0.60, 0.67, p<0.001)) for oCAD (Figure 1).
Conclusions
In this multinational pooled cohort, a previously described novel machine learning, multiple biomarker panel provided high accuracy to diagnose patients for oCAD.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Prevencio, Inc. Table 1. Pooled Variable DataFigure 1. ROC for HART CADhs and hs-cTnI
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Affiliation(s)
- J T Neumann
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany, Germany
| | - N A Sorenson
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany, Germany
| | - C P McCarthy
- Massachusetts General Hospital, Medicine, Division of Cardiology, Boston, United States of America
| | - C A Magaret
- Prevencio, Inc., Kirkland, United States of America
| | - R F Rhyne
- Prevencio, Inc., Kirkland, United States of America
| | - C C Peters
- Prevencio, Inc., Kirkland, United States of America
| | - G Barnes
- Prevencio, Inc., Kirkland, United States of America
| | - C R Defilippi
- Inova Heart and Vascular Institute, Falls Church, VA, United States of America
| | - D Westermann
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany, Germany
| | - J L Januzzi
- Massachusetts General Hospital, Medicine, Division of Cardiology, Boston, United States of America
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22
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McCarthy CP, Kolte D, Kennedy KF, Pandey A, Raber I, Oseran A, Wadhera RK, Vaduganathan M, Januzzi JL, Wasfy JH. Hospitalizations and Outcomes of T1MI Observed Before and After the Introduction of MI Subtype Codes. J Am Coll Cardiol 2021; 78:1242-1253. [PMID: 34531025 DOI: 10.1016/j.jacc.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND International Classification of Disease (ICD)-10 coding of type 1 myocardial infarction (MI) is used for reimbursement, value-based programs, and clinical research. OBJECTIVES This study sought to determine whether the introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with changes in hospitalizations for ICD-10 codes now attributed to type 1 MI. METHODS Using the Nationwide Readmissions Database, we identified patients with ICD-10 codes now attributed to type 1 MI between January 2016 and December 2018. Patients were stratified according to the timing of their event in relation to the introduction of the type 2 and types 3-5 MI codes on October 1, 2017. RESULTS There were 2,680,323 hospitalizations for ICD-10 codes now attributed to type 1 MI; after adjustment for seasonality, there was a 13.7% decline in hospitalizations after the introduction of the new subtype codes. Patients with ICD-10 codes now attributed to type 1 MI after the coding change were less likely to be female, had lower prevalence of several cardiovascular and noncardiovascular comorbidities, and had higher rates of coronary angiography and revascularization. After introduction of the new codes, there was a positive deflection in the slope of risk-adjusted in-hospital mortality (0.007%; P <0.001) and a negative deflection in risk-adjusted 30-day readmission (-0.002%; P = 0.05) for patients with ICD-10 codes now attributed to type 1 MI. CONCLUSIONS The introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with a decrease in hospitalizations for ICD-10 codes now attributed to type 1 MI and changes in the observed characteristics and treatment patterns of these patients.
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Affiliation(s)
- Cian P McCarthy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dhaval Kolte
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Inbar Raber
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Oseran
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rishi K Wadhera
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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23
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Allard-Ratick MP, McCarthy CP, Jang IK. Letter by Allard-Ratick et al Regarding Article, "Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women". Circulation 2021; 144:e206. [PMID: 34543073 DOI: 10.1161/circulationaha.120.053480] [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: 11/16/2022]
Affiliation(s)
- Marc P Allard-Ratick
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Cian P McCarthy
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston
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24
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Raber I, Al Rifai M, McCarthy CP, Vaduganathan M, Michos ED, Wood MJ, Smyth YM, Ibrahim NE, Asnani A, Mehran R, McEvoy JW. Gender Differences in Medicare Payments Among Cardiologists. JAMA Cardiol 2021; 6:1432-1439. [PMID: 34495296 DOI: 10.1001/jamacardio.2021.3385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 02/01/2023]
Abstract
Importance Women cardiologists receive lower salaries than men; however, it is unknown whether US Centers for Medicare & Medicaid Services (CMS) reimbursement also differs by gender and contributes to the lower salaries. Objective To determine whether gender differences exist in the reimbursements, charges, and reimbursement per charge from CMS. Design, Setting, and Participants This cross-sectional analysis used the CMS database to obtain 2016 reimbursement data for US cardiologists. These included reimbursements to cardiologists, charges submitted, and unique billing codes. Gender differences in reimbursement for evaluation and management and procedural charges from both inpatient and outpatient settings were also assessed. Analysis took place between April 2019 and December 2020. Main Outcomes and Measures Outcomes included median CMS payments received and median charges submitted in the inpatient and outpatient settings in 2016. Results In 2016, 17 524 cardiologists (2312 women [13%] and 15 212 men [87%]) received CMS payments in the inpatient setting, and 16 929 cardiologists (2151 women [13%] and 14 778 men [87%]) received CMS payments in the outpatient setting. Men received higher median payments in the inpatient (median [interquartile range], $62 897 [$30 904-$104 267] vs $45 288 [$21 371-$73 191]; P < .001) and outpatient (median [interquartile range], $91 053 [$34 820-$196 165] vs $51 975 [$15 622-$120 175]; P < .001) practice settings. Men submitted more median charges in the inpatient (median [interquartile range], 1190 [569-2093] charges vs 959 [569-2093] charges; P < .001) and outpatient settings (median [interquartile range], 1685 [644-3328] charges vs 870 [273-1988] charges; P < .001). In a multivariable-adjusted linear regression analysis, women received less CMS payments compared with men (log-scale β = -0.06; 95% CI, -0.11 to -0.02) after adjustment for number of charges, number of unique billing codes, complexity of patient panel, years since graduation of physicians, and physician subspecialty. Payment by billing codes, both inpatient and outpatient, did not differ by gender. Conclusions and Relevance There may be potential differences in CMS payments between men and women cardiologists, which appear to stem from gender differences in the number and types of charges submitted. The mechanisms behind these differences merit further research, both to understand why such gender differences exist and also to facilitate reductions in pay disparities.
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Affiliation(s)
- Inbar Raber
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yvonne M Smyth
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nasrien E Ibrahim
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Aarti Asnani
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
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25
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McCarthy CP, Jones-O'Connor M, Olshan DS, Murphy S, Rehman S, Cohen JA, Cui J, Singh A, Vaduganathan M, Januzzi JL, Wasfy JH. The Intersection of Type 2 Myocardial Infarction and Heart Failure. J Am Heart Assoc 2021; 10:e020849. [PMID: 34423653 PMCID: PMC8649278 DOI: 10.1161/jaha.121.020849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Type 2 myocardial infarction (T2MI) is common and associated with high cardiovascular event rates. However, the relationship between T2MI and heart failure (HF) is uncertain. Methods and Results We identified patients with T2MI at a large tertiary hospital between October 2017 and May 2018. Patient characteristics, causes of T2MI, and subsequent HF hospitalizations were determined by physician chart review. We identified 359 patients with T2MI over the study period; 184 patients had a history of HF. Among patients with ejection fraction (EF) assessment (N=180), the majority had preserved EF (N=107; 59.4%), followed by reduced EF (N=54; 30.0%), and mid‐range EF (N=19; 10.6%). Acute HF was the most common cause of T2MI (20.9%). Of those whose T2MI was precipitated by HF (N=75), the mean EF was 53.0±16.8% and 16 (21.3%) were de novo diagnoses of HF. Among patients with T2MI who were discharged alive with available follow‐up (N=289), 5.5% were hospitalized with acute HF within 30 days, 17.3% within 180 days, and 22.1% within 1 year. In subgroup analyses, among patients with T2MI with prevalent or new HF (N=161), the rate of HF hospitalization at 1 year was 34.2%, considerably higher than those with T2MI and no HF diagnosis at discharge (7.0%; N=9/128). Conclusions Index presentations of HF or worsening chronic HF represent the most common causes of T2MI. ≈1 in 5 patients with T2MI will be readmitted for HF within 1 year of their event. Strategies to prevent HF events after a T2MI are needed.
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | | | - David S Olshan
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Sean Murphy
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Saad Rehman
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Joshua A Cohen
- Division of Cardiology Department of Medicine Cleveland Clinic Cleveland OH
| | - Jinghan Cui
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - James L Januzzi
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Jason H Wasfy
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
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26
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Affiliation(s)
- James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
| | - Cian P McCarthy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/CianPMcCarthy
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27
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Raber I, McCarthy CP, Januzzi JL. A Test in Context: Interpretation of High-Sensitivity Cardiac Troponin Assays in Different Clinical Settings. J Am Coll Cardiol 2021; 77:1357-1367. [PMID: 33706879 DOI: 10.1016/j.jacc.2021.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
High-sensitivity cardiac troponin (hs-cTn) assays have the ability to detect minute troponin concentrations and resolve minor changes in biomarker concentrations. Clinically, this allows for the ability to rapidly identify or exclude acute myocardial injury in the setting of acute chest discomfort-thus providing more rapid evaluation for acute myocardial infarction-but the improvements in troponin assays also create avenues for other applications where troponin release from the cardiomyocyte might confer prognostic information. These situations include cardiovascular risk assessment across a wide range of clinical circumstances, including apparently-well individuals, those at risk for heart disease, and those with prevalent cardiovascular disorders. The optimal hs-cTn threshold for each circumstance varies by the assay used and by the population assessed. This review will provide context for how hs-cTn assays might be interpreted depending on the application sought, reviewing results from studies leveraging hs-cTn for applications beyond "acute myocardial infarction diagnostic evaluation."
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Affiliation(s)
- Inbar Raber
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/InbarRaber
| | - Cian P McCarthy
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/CianPMcCarthy
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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McCarthy CP, Kolte D, Kennedy KF, Vaduganathan M, Wasfy JH, Januzzi JL. Patient Characteristics and Clinical Outcomes of Type 1 Versus Type 2 Myocardial Infarction. J Am Coll Cardiol 2021; 77:848-857. [PMID: 33602466 DOI: 10.1016/j.jacc.2020.12.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 2 myocardial infarction (MI) patients may have different characteristics and outcomes when compared with type 1 MI. OBJECTIVES The purpose of this study was to compare patients with type 1 MI to those with type 2 MI in the United States. METHODS Using the Nationwide Readmissions Database, MI patients were categorized over the 3 months following the introduction of an International Classification of Diseases-10th Revision code specific for type 2 MI. Baseline characteristics and inpatient and post-discharge outcomes among both cohorts were compared. RESULTS There were 216,657 patients with type 1 MI, 37,765 patients with type 2 MI, and 1,525 patients with both type 1 and 2 MI. Patients with type 2 MI were older (71 years vs. 69 years; p < 0.001), were more likely to be women (47.3% vs. 40%; p < 0.001), and had higher prevalence of heart failure (27.9% vs. 10.9%; p < 0.001), kidney disease (35.7% vs. 25.7%; p < 0.001), and atrial fibrillation (31% vs. 21%; p < 0.001). Rates of coronary angiography (10.9% vs. 57.3%; p < 0.001), percutaneous coronary intervention (1.7% vs. 38.5%; p < 0.001), and coronary artery bypass grafting (0.4% vs. 7.8%; p < 0.001) were lower among type 2 MI patients. Patients with type 2 MI had lower risk of in-hospital mortality (adjusted odds ratio: 0.57 [95% confidence interval: 0.54 to 0.60]) and 30-day MI readmission (adjusted odds ratio: 0.46 [95% confidence interval: 0.35 to 0.59]). There was no difference in risk of 30-day all-cause or heart failure readmission. CONCLUSIONS Patients with type 2 MI have a unique cardiovascular phenotype when compared with type 1 MI, and are managed in a heterogenous manner. Validated management strategies for type 2 MI are needed.
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dhaval Kolte
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Murphy SP, Kakkar R, McCarthy CP, Januzzi JL. Inflammation in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1324-1340. [PMID: 32192660 DOI: 10.1016/j.jacc.2020.01.014] [Citation(s) in RCA: 239] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/08/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
It has long been observed that heart failure (HF) is associated with measures of systemic inflammation. In recent years, there have been significant advancements in our understanding of how inflammation contributes to the pathogenesis and progression of HF. However, although numerous studies have validated the association between measures of inflammation and HF severity and prognosis, clinical trials of anti-inflammatory therapies have proven mostly unsuccessful. On this backdrop emerges the yet unmet goal of targeting precise phenotypes within the syndrome of HF; if such precise definitions can be realized, and with better understanding of the roles played by specific inflammatory mediators, the expectation is that targeted anti-inflammatory therapies may improve prognosis in patients whose HF is driven by inflammatory pathobiology. Here, the authors describe mechanistic links between inflammation and HF, discuss traditional and novel inflammatory biomarkers, and summarize the latest evidence from clinical trials of anti-inflammatory therapies.
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Affiliation(s)
- Sean P Murphy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rahul Kakkar
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
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30
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - James L Januzzi
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
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31
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McCarthy CP, Olshan DS, Rehman S, Jones-O'Connor M, Murphy S, Cohen JA, Singh A, Vaduganathan M, Januzzi JL, Wasfy JH. Cardiologist Evaluation of Patients With Type 2 Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 14:e007440. [PMID: 33161772 DOI: 10.1161/circoutcomes.120.007440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine (C.P.M., J.L.J., J.H.W.), Massachusetts General Hospital, Boston
| | - David S Olshan
- Department of Medicine (D.S.O., S.R., M.J.-O., S.M.), Massachusetts General Hospital, Boston
| | - Saad Rehman
- Department of Medicine (D.S.O., S.R., M.J.-O., S.M.), Massachusetts General Hospital, Boston
| | - Maeve Jones-O'Connor
- Department of Medicine (D.S.O., S.R., M.J.-O., S.M.), Massachusetts General Hospital, Boston
| | - Sean Murphy
- Department of Medicine (D.S.O., S.R., M.J.-O., S.M.), Massachusetts General Hospital, Boston
| | - Joshua A Cohen
- Division of Cardiology, Department of Medicine, Cleveland Clinic, OH (J.A.C.)
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (M.V.)
| | - James L Januzzi
- Division of Cardiology, Department of Medicine (C.P.M., J.L.J., J.H.W.), Massachusetts General Hospital, Boston
| | - Jason H Wasfy
- Division of Cardiology, Department of Medicine (C.P.M., J.L.J., J.H.W.), Massachusetts General Hospital, Boston
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Donnellan E, Wazni OM, Kanj M, Baranowski B, Cremer P, Harb S, McCarthy CP, McEvoy JW, Elshazly MB, Aagaard P, Tarakji KG, Jaber WA, Schauer PR, Saliba WI. Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation. Europace 2020; 21:1476-1483. [PMID: 31304532 DOI: 10.1093/europace/euz183] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 04/11/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. METHODS AND RESULTS In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05-0.39; P = 0.002). CONCLUSION Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Paul Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John W McEvoy
- National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip Aagaard
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip R Schauer
- Department of Bariatric Surgery, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
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Jacobsen AP, Raber I, McCarthy CP, Blumenthal RS, Bhatt DL, Cusack RW, Serruys PWJC, Wijns W, McEvoy JW. Lifelong Aspirin for All in the Secondary Prevention of Chronic Coronary Syndrome: Still Sacrosanct or Is Reappraisal Warranted? Circulation 2020; 142:1579-1590. [PMID: 32886529 DOI: 10.1161/circulationaha.120.045695] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Four decades have passed since the first trial suggesting the efficacy of aspirin in the secondary prevention of myocardial infarction. Further trials, collectively summarized by the Antithrombotic Trialists' Collaboration, solidified the historical role of aspirin in secondary prevention. Although the benefit of aspirin in the immediate phase after a myocardial infarction remains incontrovertible, a number of emerging lines of evidence, discussed in this narrative review, raise some uncertainty as to the primacy of aspirin for the lifelong management of all patients with chronic coronary syndrome (CCS). For example, data challenging the previously unquestioned role of aspirin in CCS have come from recent trials where aspirin was discontinued in specific clinical scenarios, including early discontinuation of the aspirin component of dual antiplatelet therapy after percutaneous coronary intervention and the withholding of aspirin among patients with both CCS and atrial fibrillation who require anticoagulation. Recent primary prevention trials have also failed to consistently demonstrate net benefit for aspirin in patients treated to optimal contemporary cardiovascular risk factor targets, indicating that the efficacy of aspirin for secondary prevention of CCS may similarly have changed with the addition of more modern secondary prevention therapies. The totality of recent evidence supports further study of the universal need for lifelong aspirin in secondary prevention for all adults with CCS, particularly in stable older patients who are at highest risk for aspirin-induced bleeding.
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Affiliation(s)
- Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD(A.P.J., R.S.B., J.W.M.)
| | - Inbar Raber
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (I.R.)
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston(C.P.M.)
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD(A.P.J., R.S.B., J.W.M.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA(D.L.B.)
| | - Ronan W Cusack
- School of Medicine, National University of Ireland Galway, Ireland(R.W.C., P.W.J.C.S., W.W., J.W.M.)
| | - Patrick W J C Serruys
- School of Medicine, National University of Ireland Galway, Ireland(R.W.C., P.W.J.C.S., W.W., J.W.M.)
| | - William Wijns
- School of Medicine, National University of Ireland Galway, Ireland(R.W.C., P.W.J.C.S., W.W., J.W.M.)
| | - John W McEvoy
- School of Medicine, National University of Ireland Galway, Ireland(R.W.C., P.W.J.C.S., W.W., J.W.M.)
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McCarthy CP, Murphy S, Jones-O'Connor M, Olshan DS, Khambhati JR, Rehman S, Cadigan JB, Cui J, Meyerowitz EA, Philippides G, Friedman LS, Kadar AY, Hibbert K, Natarajan P, Massaro AF, Bohula EA, Morrow DA, Woolley AE, Januzzi JL, Wasfy JH. Early clinical and sociodemographic experience with patients hospitalized with COVID-19 at a large American healthcare system. EClinicalMedicine 2020; 26:100504. [PMID: 32838244 PMCID: PMC7434634 DOI: 10.1016/j.eclinm.2020.100504] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite over 4 million cases of novel coronavirus disease 2019 (COVID-19) in the United States, limited data exist including socioeconomic background and post-discharge outcomes for patients hospitalized with this disease. METHODS In this case series, we identified patients with COVID-19 admitted to 3 Partners Healthcare hospitals in Boston, Massachusetts between March 7th, 2020, and March 30th, 2020. Patient characteristics, treatment strategies, and outcomes were determined. FINDINGS A total of 247 patients hospitalized with COVID-19 were identified; the median age was 61 (interquartile range [IQR]: 50-76 years), 58% were men, 30% of Hispanic ethnicity, 21% enrolled in Medicaid, and 12% dual-enrolled Medicare/Medicaid. The median estimated household income was $66,701 [IQR: $50,336-$86,601]. Most patients were treated with hydroxychloroquine (72%), and statins (76%; newly initiated in 34%). During their admission, 103 patients (42%) required intensive care. At the end of the data collection period (June 24, 2020), 213 patients (86.2%) were discharged alive, 2 patients (0.8%) remain admitted, and 32 patients (13%) have died. Among those discharged alive (n = 213), 70 (32.9%) were discharged to a post-acute facility, 31 (14.6%) newly required supplemental oxygen, 19 (8.9%) newly required tube feeding, and 34 (16%) required new prescriptions for antipsychotics, benzodiazepines, methadone, or opioids. Over a median post-discharge follow-up of 80 days (IQR, 68-84), 22 patients (10.3%) were readmitted. INTERPRETATION Patients hospitalized with COVID-19 are frequently of vulnerable socioeconomic status and often require intensive care. Patients who survive COVID-19 hospitalization have substantial need for post-acute services.
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Affiliation(s)
- Cian P. McCarthy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, United States of America
| | - Sean Murphy
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Maeve Jones-O'Connor
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - David S. Olshan
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jay R. Khambhati
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, United States of America
| | - Saad Rehman
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - John B. Cadigan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jinghan Cui
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Eric A. Meyerowitz
- Harvard Medical School, Boston, MA, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - George Philippides
- Division of Cardiology, Department of Medicine, Newton-Wellesley Hospital, Newton, MA, United States of America
- Tufts University Medical School, Boston, MA, United States of America
| | - Lawrence S. Friedman
- Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Tufts University Medical School, Boston, MA, United States of America
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA, United States of America
| | - Aran Y. Kadar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Newton-Wellesley Hospital, Newton, MA, United States of America
| | - Kathryn Hibbert
- Harvard Medical School, Boston, MA, United States of America
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
| | - Anthony F. Massaro
- Harvard Medical School, Boston, MA, United States of America
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Erin A. Bohula
- Harvard Medical School, Boston, MA, United States of America
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States of America
| | - David A. Morrow
- Harvard Medical School, Boston, MA, United States of America
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States of America
| | - Ann E. Woolley
- Harvard Medical School, Boston, MA, United States of America
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States of America
| | - James L. Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, United States of America
| | - Jason H. Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA, United States of America
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McCarthy CP, Neumann JT, Michelhaugh SA, Ibrahim NE, Gaggin HK, Sörensen NA, Schäefer S, Zeller T, Magaret CA, Barnes G, Rhyne RF, Westermann D, Januzzi JL. Derivation and External Validation of a High-Sensitivity Cardiac Troponin-Based Proteomic Model to Predict the Presence of Obstructive Coronary Artery Disease. J Am Heart Assoc 2020; 9:e017221. [PMID: 32757795 PMCID: PMC7660799 DOI: 10.1161/jaha.120.017221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Current noninvasive modalities to diagnose coronary artery disease (CAD) have several limitations. We sought to derive and externally validate a hs‐cTn (high‐sensitivity cardiac troponin)–based proteomic model to diagnose obstructive coronary artery disease. Methods and Results In a derivation cohort of 636 patients referred for coronary angiography, predictors of ≥70% coronary stenosis were identified from 6 clinical variables and 109 biomarkers. The final model was first internally validated on a separate cohort (n=275) and then externally validated on a cohort of 241 patients presenting to the ED with suspected acute myocardial infarction where ≥50% coronary stenosis was considered significant. The resulting model consisted of 3 clinical variables (male sex, age, and previous percutaneous coronary intervention) and 3 biomarkers (hs‐cTnI [high‐sensitivity cardiac troponin I], adiponectin, and kidney injury molecule‐1). In the internal validation cohort, the model yielded an area under the receiver operating characteristic curve of 0.85 for coronary stenosis ≥70% (P<0.001). At the optimal cutoff, we observed 80% sensitivity, 71% specificity, a positive predictive value of 83%, and negative predictive value of 66% for ≥70% stenosis. Partitioning the score result into 5 levels resulted in a positive predictive value of 97% and a negative predictive value of 89% at the highest and lowest levels, respectively. In the external validation cohort, the score performed similarly well. Notably, in patients who had myocardial infarction neither ruled in nor ruled out via hs‐cTnI testing (“indeterminate zone,” n=65), the score had an area under the receiver operating characteristic curve of 0.88 (P<0.001). Conclusions A model including hs‐cTnI can predict the presence of obstructive coronary artery disease with high accuracy including in those with indeterminate hs‐cTnI concentrations.
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Johannes T Neumann
- Department of Cardiology University Heart & Vascular Center Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | | | | | - Hanna K Gaggin
- Division of Cardiology Massachusetts General Hospital Boston MA.,Cardiometabolic Trials Baim Institute for Clinical Research Boston MA
| | - Nils A Sörensen
- Department of Cardiology University Heart & Vascular Center Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | - Sarina Schäefer
- Department of Cardiology University Heart & Vascular Center Hamburg Germany
| | - Tanja Zeller
- Department of Cardiology University Heart & Vascular Center Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | | | | | | | - Dirk Westermann
- Department of Cardiology University Heart & Vascular Center Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck Hamburg Germany
| | - James L Januzzi
- Division of Cardiology Massachusetts General Hospital Boston MA.,Cardiometabolic Trials Baim Institute for Clinical Research Boston MA
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McCarthy CP, Raber I, Chapman AR, Sandoval Y, Apple FS, Mills NL, Januzzi JL. Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays: A Practical Approach for Clinicians. JAMA Cardiol 2020; 4:1034-1042. [PMID: 31389986 DOI: 10.1001/jamacardio.2019.2724] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [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: 12/21/2022]
Abstract
Importance Traditionally, elevated troponin concentrations were synonymous with myocardial infarction. But with improvements in troponin assays, elevated concentrations without overt myocardial ischemia are now more common; this is referred to as myocardial injury. Physicians may be falsely reassured by the absence of myocardial ischemia; however, recent evidence suggests that myocardial injury is associated with even more detrimental outcomes. Accordingly, this article reviews the definition, epidemiology, differential diagnosis, diagnostic evaluation, and management of myocardial injury. Observations Current epidemiological evidence suggests that myocardial injury without overt ischemia represents about 60% of cases of abnormal troponin concentrations when obtained for clinical indications, and 1 in 8 patients presenting to the hospital will have evidence of myocardial injury. Myocardial injury is a concerning prognosis; the 5-year mortality rate is approximately 70%, with a major adverse cardiovascular event rate of 30% in the same period. The differential diagnosis is broad and can be divided into acute and chronic precipitants. The initial workup involves an assessment for myocardial ischemia. If infarction is ruled out, further evaluation includes a detailed history, physical examination, laboratory testing, a 12-lead electrocardiogram, and (if there is no known history of structural or valvular heart disease) an echocardiogram. Unfortunately, no consensus exists on routine management of patients with myocardial injury. Identifying and treating the underlying precipitant is the most practical approach. Conclusion and Relevance Myocardial injury is the most common cause of abnormal troponin results, and its incidence will likely increase with an aging population, increasing prevalence of cardiovascular comorbidities, and greater sensitivity of troponin assays. Myocardial injury represents a challenge to clinicians; however, given its serious prognosis, it warrants a thorough evaluation of its underlying precipitant. Future strategies to prevent and/or manage myocardial injury are needed.
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Affiliation(s)
- Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Inbar Raber
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andrew R Chapman
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/Hennepin County Medical Center and University of Minnesota, Minneapolis
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston.,Baim Institute for Clinical Research, Boston, Massachusetts
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McCarthy CP, Murphy S, Rehman S, Jones-O'Connor M, Olshan DS, Cohen JA, Cui J, Singh A, Vaduganathan M, Januzzi JL, Wasfy JH. Home-Time After Discharge Among Patients With Type 2 Myocardial Infarction. J Am Heart Assoc 2020; 9:e015978. [PMID: 32384008 PMCID: PMC7660891 DOI: 10.1161/jaha.119.015978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Home-time, defined as the time spent alive outside of a healthcare institution, has emerged as a patient-centered health outcome. The discharge locations and distribution of home-time after a type 2 myocardial infarction are unknown. Methods and Results Patients with a type 2 myocardial infarction between October 2017 and May 2018 at Massachusetts General Hospital were included. Patients discharged to hospice or without follow-up data were excluded. Our primary outcome was home-time defined as the number of days lived outside of a hospital, long-term acute care facility, skilled nursing facility, or rehabilitation facility. We identified 359 patients with type 2 myocardial infarction over the study period. Of those discharged alive (N=321), 62.9% were discharged home, and the remainder went to a facility or hospice. Among those with available follow-up data (N=289), the median home-time was 30 (interquartile range [IQR], 16-30) days at 30 days, 171 (IQR, 133-180) days at 180 days, and 347 (IQR, 203-362) days at 365 days. At 1 year, 29 patients (10%) with type 2 myocardial infarction had spent no time at home and only 57 patients (19.7%) spent the entire year alive and at home. At 1 year, postdischarge all-cause mortality was 23.2%, all-cause readmission was 69.2%, and major adverse cardiovascular events (composite of all-cause mortality, recurrent myocardial infarction, or stroke) was 34.9%. Home-time through 1 year correlated strongly with time-to-event all-cause mortality (τ=0.54, P<0.001) and major adverse cardiovascular events (τ=0.52, P<0.001) and modestly with a composite of all-cause mortality or readmission (τ=0.44, P<0.001). Conclusions Home-time is low after a hospitalization for type 2 myocardial infarction and correlates strongly with mortality and major adverse cardiovascular events.
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Sean Murphy
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Saad Rehman
- Department of Medicine Massachusetts General Hospital Boston MA
| | | | - David S Olshan
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Joshua A Cohen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland OH
| | - Jinghan Cui
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - James L Januzzi
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Jason H Wasfy
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
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Raber I, McCarthy CP, Al Rifai M, Vaduganathan M, Michos ED, Wood MJ, Smyth YM, Ibrahim NE, DeFaria Yeh D, Asnani A, Mehran R, McEvoy JW. Gender differences in industry payments among cardiologists. Am Heart J 2020; 223:123-131. [PMID: 31926591 DOI: 10.1016/j.ahj.2019.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a wage gap among men and women practicing cardiology. Differences in industry funding can be both a consequence of and a contributor to gender differences in salaries. We sought to determine whether gender differences exist in the distribution, types, and amounts of industry payments among men and women in cardiology. METHODS In this cross-sectional analysis, we used the Centers for Medicare & Medicaid Services Open Payment program database to obtain 2016 industry payment data for US cardiologists. We also used UK Disclosure data to obtain 2016 industry payments to UK cardiologists. Outcomes included the proportions of male and female cardiologists receiving industry funding and the mean industry payment amounts received by male and female cardiologists. Where possible, we also assessed 2014 and 2015 data in both locations. RESULTS Of the 22,848 practicing Centers for Medicare & Medicaid Services US cardiologists in 2016, 20,037 (88%) were men and 2,811 (12%) were women. Proportionally more men than women received industry payments in 2016 (78.0% vs 68.5%, respectively; P < .001). Men received higher overall mean industry payments than women ($6,193.25 vs. $2,501.55, P < .001). Results were similar in 2014 and 2015. Among UK cardiologists, more men (24.4%) than women (13.5%) received industry payments in 2016 (P < .001). However, although the difference in overall industry payments was numerically larger among men compared to women, this did not achieve statistical significance (£2,348.31 vs £1,501.37, respectively, P = .35). CONCLUSIONS Industry payments to cardiologists are common, and there are gender differences in these payments on both sides of the Atlantic.
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Affiliation(s)
- Inbar Raber
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mahmoud Al Rifai
- Department of Cardiology, Baylor College of Medicine, Houston, TX
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yvonne M Smyth
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nasrien E Ibrahim
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aarti Asnani
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
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McCarthy CP, Murphy S, Rehman S, Jones-O'Connor M, Olshan D, Cohen J, Cui J, Singh A, Vaduganathan M, Januzzi J, Wasfy JH. HEART FAILURE EVENTS AFTER TYPE 2 MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30752-x] [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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Abboud A, Camacho A, Nguonly A, Fiseha N, Bean A, Osborne MT, Ibrahim NE, McCarthy CP, Tawakol A, Ruberg FL, Sadjadi R, David WS, Lewis GD, Januzzi JL, Gaggin H. CARE TRAJECTORY AND EARLY CLINICAL FEATURES AMONG PATIENTS WITH 99MTC-PYROPHOSPHATE POSITIVE TRANSTHYRETIN AMYLOID CARDIOMYOPATHY (ATTR-CM). J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Januzzi JL, McCarthy CP. Cardiac Troponin and the True False Positive. JACC Case Rep 2020; 2:461-463. [PMID: 34317264 PMCID: PMC8311704 DOI: 10.1016/j.jaccas.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- James L. Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Cian P. McCarthy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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Ibrahim NE, McCarthy CP, Shrestha S, Gaggin HK, Mukai R, Szymonifka J, Apple FS, Burnett JC, Iyer S, Januzzi JL. Effect of Neprilysin Inhibition on Various Natriuretic Peptide Assays. J Am Coll Cardiol 2020; 73:1273-1284. [PMID: 30898202 DOI: 10.1016/j.jacc.2018.12.063] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [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: 07/05/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND With sacubitril/valsartan treatment, B-type natriuretic peptide (BNP) concentrations increase; it remains unclear whether change in BNP concentrations is similar across all assays for its measurement. Effects of sacubitril/valsartan on atrial natriuretic peptide (ANP) concentrations in patients are unknown. Lastly, the impact of neprilysin inhibition on mid-regional pro-ANP (MR-proANP), N-terminal pro-BNP (NT-proBNP), proBNP1-108, or C-type natriuretic peptide (CNP) is not well understood. OBJECTIVES This study sought to examine the effects of sacubitril/valsartan on results from different natriuretic peptide assays. METHODS Twenty-three consecutive stable patients with heart failure and reduced ejection fraction were initiated and titrated on sacubitril/valsartan. Change in ANP, MR-proANP, BNP (using 5 assays), NT-proBNP (3 assays), proBNP1-108, and CNP were measured over 3 visits. RESULTS Average time to 3 follow-up visits was 22, 46, and 84 days. ANP rapidly and substantially increased with initiation and titration of sacubitril/valsartan, more than doubling by the first follow-up visit (+105.8%). Magnitude of ANP increase was greatest in those with concentrations above the median at baseline (+188%) compared with those with lower baseline concentrations (+44%); ANP increases were sustained. Treatment with sacubitril/valsartan led to inconsistent changes in BNP, which varied across methods assessed. Concentrations of MR-proANP, NT-proBNP, and proBNP1-108 variably declined after treatment; whereas CNP concentrations showed no consistent change. CONCLUSIONS Initiation and titration of sacubitril/valsartan led to variable changes in concentrations of multiple natriuretic peptides. These results provide important insights into the effects of sacubitril/valsartan treatment on individual patient results, and further suggest the benefit of neprilysin inhibition may be partially mediated by increased ANP concentrations.
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Affiliation(s)
- Nasrien E Ibrahim
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Cian P McCarthy
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Shreya Shrestha
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Hanna K Gaggin
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Renata Mukai
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Fred S Apple
- Laboratory Medicine & Pathology, Hennepin County Medical Center & University of Minnesota, Minneapolis, Minnesota
| | | | | | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Baim Institute for Clinical Research, Boston, Massachusetts.
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Vaduganathan M, Patel RB, Singh A, McCarthy CP, Qamar A, Januzzi JL, Scirica BM, Butler J, Cannon CP, Bhatt DL. Prescription of Glucagon-Like Peptide-1 Receptor Agonists by Cardiologists. J Am Coll Cardiol 2020; 73:1596-1598. [PMID: 30922481 DOI: 10.1016/j.jacc.2019.01.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/17/2018] [Accepted: 01/10/2019] [Indexed: 11/27/2022]
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McCarthy CP, Vaduganathan M, Solomon E, Sakhuja R, Piazza G, Bhatt DL, Connors JM, Patel NK. Running thin: implications of a heparin shortage. Lancet 2020; 395:534-536. [PMID: 31982034 DOI: 10.1016/s0140-6736(19)33135-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/04/2019] [Revised: 12/01/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Muthiah Vaduganathan
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edmond Solomon
- Department of Pharmacy, Massachusetts General School, Boston, MA, USA
| | - Rahul Sakhuja
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Piazza
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jean M Connors
- Division of Hematology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nilay K Patel
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Vaduganathan M, McCarthy CP, Ayers C, Bhatt DL, Kumbhani DJ, de Lemos JA, Fonarow GC, Pandey A. Longitudinal trajectories of hospital performance across targeted cardiovascular conditions in the USA. Eur Heart J Qual Care Clin Outcomes 2020; 6:62-71. [PMID: 31124567 DOI: 10.1093/ehjqcco/qcz026] [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] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 12/23/2022]
Abstract
AIMS Thirty-day risk standardized readmission and mortality rates (RSRR, RSMR) are key determinants for hospital performance for cardiovascular conditions such as acute myocardial infarction (AMI) and heart failure (HF). We evaluated whether individual hospitals in the USA perform similarly for HF and AMI over time based on readmission and mortality metrics. METHODS AND RESULTS A total of 1950 hospitals in the USA with continuous participation in the Centers for Medicare and Medicaid Services (CMS) public reporting programme between 2010 and 2016 were identified. Latent mixture modelling was used to define performance trajectory groups. Overall, there were consistent declines in the RSMR (16.1-14.0%) and RSRR (20.3-16.6%) for AMI from 2010 to 2016. For HF, RSRR declined over time (25.1-21.7%), while there was a modest increase in RSMR (11.3-12.0%); parallel findings were observed across performance trajectory groups. The proportion of best performing centres for HF care that were also best performers for AMI care based on the 30-day RSMR and 30-day RSRR metric was 54% and 35%, respectively. Furthermore, the discordance rate between the best and worst performers for both conditions was low (<2% for both 30-day outcomes). CONCLUSION In the USA, despite variation in baseline hospital-level outcomes, hospitals had consistent longitudinal trajectories (worsening or improvement) across conditions and metrics. Hospitals identified as high performing were frequently similar across target conditions and over time, suggesting that performance may be driven by systems of care influencing different disease states in a comparable manner.
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Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, 100 Medical Plaza Driveway, Los Angeles, CA 90095, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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McCarthy CP, Steg G, Bhatt DL. The management of antiplatelet therapy in acute coronary syndrome patients with thrombocytopenia: a clinical conundrum. Eur Heart J 2019; 38:3488-3492. [PMID: 29020292 PMCID: PMC5837661 DOI: 10.1093/eurheartj/ehx531] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Gabriel Steg
- Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), an F-CRIN Network, Université Paris-Diderot, Sorbonne Paris-Cité, INSERM U-1148, Paris, France
- NHLI, Imperial College, ICMS Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
- Corresponding author. Tel: +1 857 307 1992, Fax: +1 857 307 1955,
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Affiliation(s)
- James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Baim Institute for Clinical Research, Boston, Massachusetts.
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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McCarthy CP, McWalters ST, Wasfy JH. ICD- 10 Coding of Type 2 Myocardial Infarction and Myocardial Injury as It Relates to US Centers for Medicare & Medicaid Services Value-Based Payment Programs—Reply. JAMA Cardiol 2019; 4:1051-1052. [DOI: 10.1001/jamacardio.2019.2821] [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: 11/14/2022]
Affiliation(s)
- Cian P. McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sean T. McWalters
- Center for Quality and Safety, Quality Incentives and Rankings, Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston
| | - Jason H. Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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McCarthy CP. Type 2 Myocardial Infarction and Value-Based Programs: Cutting the Supply in the Absence of Demand. Am J Med 2019; 132:1117-1118. [PMID: 30871926 DOI: 10.1016/j.amjmed.2019.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston.
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