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Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, Robertson S, Wilson K, Mellett-Smith A, Fothergill RT, McCrone P, Dalby M, MacCarthy P, Firoozi S, Malik I, Rakhit R, Jain A, Nolan JP, Redwood SR. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet 2023; 402:1329-1337. [PMID: 37647928 PMCID: PMC10877072 DOI: 10.1016/s0140-6736(23)01351-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 06/13/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The International Liaison Committee on Resuscitation has called for a randomised trial of delivery to a cardiac arrest centre. We aimed to assess whether expedited delivery to a cardiac arrest centre compared with current standard of care following resuscitated cardiac arrest reduces deaths. METHODS ARREST is a prospective, parallel, multicentre, open-label, randomised superiority trial. Patients (aged ≥18 years) with return of spontaneous circulation following out-of-hospital cardiac arrest without ST elevation were randomly assigned (1:1) at the scene of their cardiac arrest by London Ambulance Service staff using a secure online randomisation system to expedited delivery to the cardiac catheter laboratory at one of seven cardiac arrest centres or standard of care with delivery to the geographically closest emergency department at one of 32 hospitals in London, UK. Masking of the ambulance staff who delivered the interventions and those reporting treatment outcomes in hospital was not possible. The primary outcome was all-cause mortality at 30 days, analysed in the intention-to-treat (ITT) population excluding those with unknown mortality status. Safety outcomes were analysed in the ITT population. The trial was prospectively registered with the International Standard Randomised Controlled Trials Registry, 96585404. FINDINGS Between Jan 15, 2018, and Dec 1, 2022, 862 patients were enrolled, of whom 431 (50%) were randomly assigned to a cardiac arrest centre and 431 (50%) to standard care. 20 participants withdrew from the cardiac arrest centre group and 19 from the standard care group, due to lack of consent or unknown mortality status, leaving 411 participants in the cardiac arrest centre group and 412 in the standard care group for the primary analysis. Of 822 participants for whom data were available, 560 (68%) were male and 262 (32%) were female. The primary endpoint of 30-day mortality occurred in 258 (63%) of 411 participants in the cardiac arrest centre group and in 258 (63%) of 412 in the standard care group (unadjusted risk ratio for survival 1·00, 95% CI 0·90-1·11; p=0·96). Eight (2%) of 414 patients in the cardiac arrest centre group and three (1%) of 413 in the standard care group had serious adverse events, none of which were deemed related to the trial intervention. INTERPRETATION In adult patients without ST elevation, transfer to a cardiac arrest centre following resuscitated cardiac arrest in the community did not reduce deaths. FUNDING British Heart Foundation.
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Affiliation(s)
- Tiffany Patterson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Department, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Gavin D Perkins
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alexander Perkins
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Tim Clayton
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Richard Evans
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Steven Robertson
- London School of Hygiene & Tropical Medicine Clinical Trials Unit, London, UK
| | - Karen Wilson
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Rachael T Fothergill
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Clinical Audit and Research Unit, London Ambulance Service, London, UK; Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Miles Dalby
- Department of Cardiology, Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Sam Firoozi
- Department of Cardiology, St Georges Hospital, London, UK
| | - Iqbal Malik
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Roby Rakhit
- Department of Cardiology, Royal Free Hospital Foundation Trust, London, UK
| | - Ajay Jain
- Department of Cardiology, Barts Heart Centre, London, UK
| | - Jerry P Nolan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Department of Anaesthesia, Royal United Hospital, Bath, UK
| | - Simon R Redwood
- Cardiovascular Department, Guy's and St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
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2
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Chick W, Alkhalil M, Egred M, Gorog DA, Edwards R, Das R, Abdeldayem T, Ibrahim O, Malik I, Mikhail G, Zaman A, Farag M. A Systematic Review and Meta-Analysis of the Clinical Outcomes of Isolated Tricuspid Valve Surgery. Am J Cardiol 2023; 203:414-426. [PMID: 37531685 DOI: 10.1016/j.amjcard.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
Patients with isolated tricuspid valve (TV) disease have poor prognosis with no consensus on their management. Transcatheter TV intervention is emerging as a valid option in patients with prohibitive surgical risk. We analyzed studies of patients who underwent isolated TV surgery to identify the features associated with successful clinical outcomes. We performed a systematic review and meta-analysis of studies reporting clinical outcomes of isolated surgical TV intervention, namely TV repair, TV replacement with a bioprosthetic valve (TVR-B), or TV replacement with a mechanical valve (TVR-M). Twenty-seven studies involving 10,478 patients (4,931 TV repair, 3,821 TVR-B, and 1,713 TVR-M) were included. Early mortality occurred in 9% and did not differ between TV surgical approaches. Late mortality was 27% at a median follow-up of 4 (3 to 6) years and was significantly higher for all-TVR (30% vs 25%, rate ratio 1.18, 95% confidence interval 1.05 to 1.31, p = 0.004) and TVR-B (28% vs 24%, rate ratio 1.15, 95% confidence interval 1.02 to 1.30, p = 0.02) compared with TV repair. Late mortality did not differ between TVR-B and TVR-M. Across all studies, early complications included bleeding (7.4%), acute kidney injury (18.7%), permanent pacemaker (13.7%), cerebrovascular accidents (1.2%), and infection (8.9%). Late clinical outcomes included reintervention (3.7%), structural valve deterioration (2.4%), valve thrombosis (2.6%), and TV regurgitation recurrence after 1 year (15.0%). In conclusion, in isolated TV surgeries, TV repair has favorable long-term mortality compared with TV replacement. This supports the development and refinement of transcatheter TV repair approaches. Future research is recommended to provide comparative data for various transcatheter TV interventions.
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Affiliation(s)
- William Chick
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Diana A Gorog
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom; Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, United Kingdom
| | - Richard Edwards
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Rajiv Das
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Tarek Abdeldayem
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Osama Ibrahim
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Iqbal Malik
- Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Mohamed Farag
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, United Kingdom.
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3
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Kanagaratnam P, Francis DP, Chamie D, Coyle C, Marynina A, Katritsis G, Paiva P, Szigeti M, Cole G, de Andrade Nunes D, Howard J, Esper R, Khan M, More R, Barreto G, Meneguz-Moreno R, Arnold A, Nowbar A, Kaura A, Mariveles M, March K, Shah J, Nijjer S, Lip GY, Mills N, Camm AJ, Cooke GS, Corbett SJ, Llewelyn MJ, Ghanima W, Toshner M, Peters N, Petraco R, Al-Lamee R, Boshoff ASM, Durkina M, Malik I, Ruparelia N, Cornelius V, Shun-Shin M. A RANDOMISED CONTROLLED TRIAL TO INVESTIGATE THE USE OF ACUTE CORONARY SYNDROME THERAPY IN PATIENTS HOSPITALISED WITH COVID-19: THE C19-ACS TRIAL. J Thromb Haemost 2023:S1538-7836(23)00428-2. [PMID: 37230416 DOI: 10.1016/j.jtha.2023.04.045] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Patients hospitalised with COVID-19 suffer thrombotic complications. Risk factors for poor outcomes are shared with coronary artery disease. OBJECTIVES To investigate efficacy of an acute coronary syndrome regimen in patients hospitalised with COVID-19 and coronary disease risk factors. PATIENTS/METHODS A randomised controlled open-label trial across acute hospitals (UK and Brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28-days. Primary efficacy and safety outcomes were 30-day mortality and bleeding. The key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, death). RESULTS 320 patients from 9 centres were randomised. The trial terminated early due to low recruitment. At 30 days there was no significant difference in mortality (intervention: 11.5% vs control: 15%, unadjusted OR 0.73, 95%CI 0.38 to 1.41, p=0.355). Significant bleeds were infrequent and not significantly different between the arms (intervention: 1.9% vs control 1.9%, p>0.999). Using a Bayesian Markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (OR 1.46, 95% CrI 0.88 to 2.37, Pr(Beta>0)=93%; adjusted OR 1.50, 95% CrI 0.91 to 2.45, Pr(Beta>0)=95%) and median time to discharge home was two days shorter (95% CrI -4 to 0, 2% probability that it was worse). CONCLUSIONS Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.
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Affiliation(s)
- Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK.
| | - Darrel P Francis
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Daniel Chamie
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Clare Coyle
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Patricia Paiva
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Matyas Szigeti
- Imperial College, London, UK; Physiological Controls Research Centre, Obuda University, Budapest, Hungary
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - James Howard
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Ranjit More
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
| | | | - Rafael Meneguz-Moreno
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil; Centro de Ensino e Pesquisa da Rede Primavera, Aracaju, Brazil; Universidade Federal de Sergipe, Lagarto, Brazil
| | - Ahran Arnold
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Amit Kaura
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | | | - Jaymin Shah
- London North West University Healthcare NHS Trust, UK
| | | | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nicholas Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A John Camm
- St George's University of London, London, UK
| | - Graham S Cooke
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Martin J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Waleed Ghanima
- Østfold Hospital: Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Mark Toshner
- Heart and Lung Research Institute, Dept of Medicine, University of Cambridge
| | - Nicholas Peters
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Rasha Al-Lamee
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | | | - Margarita Durkina
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
| | - Neil Ruparelia
- Imperial College Healthcare NHS Trust, London, UK; Royal Berkshire Hospital NHS Trust, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London
| | - Matthew Shun-Shin
- Imperial College Healthcare NHS Trust, London, UK; Imperial College, London, UK
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Foley MJ, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee RK, Sen S. CRT-700.27 Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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5
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Foley M, Hall K, Howard JP, Ahmad Y, Gandhi M, Mahboobani S, Okafor J, Rahman H, Hadjiloizou N, Ruparelia N, Mikhail G, Malik I, Kanaganayagam G, Sutaria N, Rana B, Ariff B, Barden E, Anderson J, Afoke J, Petraco R, Al-Lamee R, Sen S. Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients. J Soc Cardiovasc Angiogr Interv 2022; 1:100349. [PMID: 35992189 PMCID: PMC9337994 DOI: 10.1016/j.jscai.2022.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/18/2022] [Indexed: 01/09/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis who are at a moderate or higher surgical risk. Stroke is a recognised and serious complication of TAVR, and it is important to identify patients at higher stroke risk. This study aims to discover if aortic valve calcium score calculated from pre-TAVR computed tomography is associated with acute stroke in TAVR patients. Methods We conducted a retrospective, observational cohort study of 433 consecutive patients undergoing TAVR between January 2017 and December 2019 at the Hammersmith Hospital. Results This cohort had a median age of 83 years (interquartile range, 78-87), and 52.7% were male. Fifty-two patients (12.0%) had a history of previous stroke or transient ischemic attack. Median aortic valve calcium score was 2145 (interquartile range, 1427-3247) Agatston units. Twenty-two patients had a stroke up to the time of discharge (5.1%). In a logistic regression model, aortic valve calcium score was significantly associated with acute stroke (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.01-1.53; P = .02). Acute stroke was also significantly associated with peripheral arterial disease (OR, 4.32; 95% CI, 1.65-10.65; P = .0018) and a longer procedure time (OR, 1.01; 95% CI, 1.00-1.02; P = .0006). Conclusions Aortic valve calcium score from pre-TAVR computed tomography is an independent risk factor for acute stroke in the TAVR population. This is an additional clinical value of the pre-TAVR aortic valve calcium score and should be considered when discussing periprocedural stroke risk.
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Affiliation(s)
- Michael Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kerry Hall
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Manisha Gandhi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samir Mahboobani
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Joseph Okafor
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Haseeb Rahman
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nearchos Hadjiloizou
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal Malik
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bushra Rana
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Edward Barden
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Anderson
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jonathan Afoke
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, London, United Kingdom
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6
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Rajkumar CA, Ganesananthan S, Ahmad Y, Seligman H, Thornton GD, Foley M, Nowbar AN, Howard JP, Francis DP, Keeble TR, Grunwald IQ, Al-Lamee RK, Malik I, Shun-Shin MJ. Mechanical thrombectomy with retrievable stents and aspiration catheters for acute ischaemic stroke: a meta-analysis of randomised controlled trials. EUROINTERVENTION 2022; 17:e1425-e1434. [PMID: 34503942 PMCID: PMC9896406 DOI: 10.4244/eij-d-21-00343] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 04/14/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Retrievable stents and aspiration catheters have been developed to provide more effective arterial recanalisation in acute ischaemic stroke. AIMS The aim of this analysis was to test the effect of mechanical thrombectomy on mortality and long-term neurological outcome in patients presenting with acute large-vessel anterior circulation ischaemic stroke. METHODS A structured search identified randomised controlled trials of thrombectomy (using a retrievable stent or aspiration catheter) versus control on a background of medical therapy which included intravenous thrombolysis if appropriate. The primary endpoint was disability at 90-day follow-up as assessed by the modified Rankin scale (mRS). Secondary endpoints included all-cause mortality and symptomatic intracranial haemorrhage. A Bayesian mixed-effects model was used for analysis. RESULTS Twelve trials met the inclusion criteria, comprising a total of 1,276 patients randomised to thrombectomy and 1,282 patients to control. Randomisation to thrombectomy significantly reduced disability at 90 days (odds ratio [OR] 0.52, 95% credible interval [CrI] 0.46 to 0.61, probability(control better)<0.0001). Furthermore, thrombectomy reduced the odds of functional dependence at 90 days, indicated by an mRS score >2 (OR 0.44, CrI 0.37 to 0.52, p<0.0001). Thrombectomy reduced all-cause mortality at 90 days (16.1% vs 19.2%, OR 0.81, 95% CrI 0.66 to 0.99, p=0.024). The frequency of symptomatic intracranial haemorrhage was similar between thrombectomy (4.2%) and control (4.0%) (OR 1.12, 95% CrI 0.76 to 1.68, p=0.72). CONCLUSIONS In patients with an acute anterior circulation stroke, modern device thrombectomy significantly reduces death and subsequent disability. The magnitude of these effects suggests that universal access to this treatment strategy should be the standard of care.
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Affiliation(s)
- Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - George D Thornton
- University College London, London, United Kingdom
- Barts Heart Centre at St Bartholomew's Hospital, London, United Kingdom
| | - Michael Foley
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alexandra N Nowbar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel P Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Basildon, United Kingdom
- Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Iris Q Grunwald
- Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
- University of Dundee, Dundee, United Kingdom
| | - Rasha K Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Matthew J Shun-Shin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
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7
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Demir OM, Little CD, Jabbour R, Rahman H, Sayers M, Ahmed A, Connolly MJ, Kanyal R, MacCarthy P, Wilson SJ, Dalby M, Jain A, Malik I, Rakhit R, Perera D. Impact of COVID-19 pandemic on the management of nonculprit lesions in patients presenting with ST-elevation myocardial infarction: Outcomes from the pan-London heart attack centers. Catheter Cardiovasc Interv 2022; 99:391-396. [PMID: 34967091 PMCID: PMC9015301 DOI: 10.1002/ccd.30056] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/21/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND The impact of COVID-19 on the diagnosis and management of nonculprit lesions remains unclear. OBJECTIVES This study sought to evaluate the management and outcomes of patients with nonculprit lesions during the COVID-19 pandemic. METHODS We conducted a retrospective observational analysis of consecutive primary percutaneous coronary intervention (PPCI) pathway activations across the heart attack center network in London, UK. Data from the study period in 2020 were compared with prepandemic data in 2019. The primary outcome was the rate of nonculprit lesion percutaneous coronary intervention (PCI) and secondary outcomes included major adverse cardiovascular events. RESULTS A total of 788 patients undergoing PPCI were identified, 209 (60%) in 2020 cohort and 263 (60%) in 2019 cohort had nonculprit lesions (p = .89). There was less functional assessment of the significance of nonculprit lesions in the 2020 cohort compared to 2019 cohort; in 8% 2020 cohort versus 15% 2019 cohort (p = .01). There was no difference in rates of PCI for nonculprit disease in the 2019 and 2020 cohorts (31% vs 30%, p = .11). Patients in 2020 cohort underwent nonculprit lesion PCI sooner than the 2019 cohort (p < .001). At 6 months there was higher rates of unplanned revascularization (4% vs. 2%, p = .05) and repeat myocardial infarction (4% vs. 1%, p = .02) in the 2019 cohort compared to 2020 cohort. CONCLUSION Changes to clinical practice during the COVID-19 pandemic were associated with reduced rates of unplanned revascularization and myocardial infarction at 6-months follow-up, and despite the pandemic, there was no difference in mortality, suggesting that it is not only safe but maybe more efficacious.
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Affiliation(s)
- Ozan M. Demir
- NIHR Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Callum D. Little
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Richard Jabbour
- Department of CardiologyImperial College Healthcare NHS Foundation TrustLondonUK
| | - Haseeb Rahman
- Department of CardiologyImperial College Healthcare NHS Foundation TrustLondonUK
| | - Max Sayers
- Department of CardiologyBarts Health NHS TrustLondonUK
| | - Asrar Ahmed
- Department of CardiologyRoyal Brompton and Harefield NHS Foundation TrustLondonUK
| | - Michelle J. Connolly
- Department of CardiologySt George's University Hospitals NHS Foundation TrustLondonUK
| | - Ritesh Kanyal
- Department of CardiologyKing's College Hospital NHS Foundation TrustLondonUK
| | - Philip MacCarthy
- Department of CardiologyKing's College Hospital NHS Foundation TrustLondonUK
| | - Simon J. Wilson
- Department of CardiologySt George's University Hospitals NHS Foundation TrustLondonUK
| | - Miles Dalby
- Department of CardiologyRoyal Brompton and Harefield NHS Foundation TrustLondonUK
| | - Ajay Jain
- Department of CardiologyBarts Health NHS TrustLondonUK
| | - Iqbal Malik
- Department of CardiologyImperial College Healthcare NHS Foundation TrustLondonUK
| | - Roby Rakhit
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Divaka Perera
- NIHR Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
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8
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Hartley A, Hammond-Haley M, Marshall DC, Salciccioli JD, Malik I, Khamis RY, Shalhoub J. Trends in mortality from aortic stenosis in Europe: 2000–2017. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1643] [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: 11/14/2022] Open
Abstract
Abstract
Background
Trends in mortality from aortic stenosis across Europe are not well understood, especially given the significant growth in transcatheter aortic valve replacement (TAVR) in the last 10 years.
Purpose
To describe trends in mortality from aortic stenosis in European countries from 2000 to 2017.
Methods
Age-standardised death rates were extracted from the World Health Organisation Mortality Database, using the International Classification of Diseases 10th edition code for non-rheumatic aortic stenosis for those aged >45 years between 2000 and 2017. The UK and countries from the European Union with at least 1,000,000 inhabitants and at least 50% available datapoints over the study period were included: a total of 23 countries. Trends were described using Joinpoint regression analysis.
Results
No reductions in mortality were demonstrated across all countries 2000–2017 (Figure 1). Large increases in mortality were found for Croatia, Poland and Slovakia for both sexes (>300% change). Mortality plateaued in Germany from 2008 in females and 2012 in males, whilst mortality in the Netherlands declined for both sexes from 2007. Mortality differences between the sexes were observed, with greater mortality for males than females across most countries.
Conclusions
Mortality from aortic stenosis has increased across Europe from 2000 to 2017. There are, however, sizable differences in mortality trends between Eastern and Western European countries. Significant plateauing or declining mortality was observed for recent years in countries with greater access to TAVR, whilst increasing trends were observed in countries with the least TAVR use. The need for health resource planning strategies to specifically target AS, particularly given the expected increase with aging populations, is highlighted.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Joinpoint regression analysis for trends in age-standardised death rates from non-rheumatic aortic stenosis for those aged >45 years in Europe from 2000 to 2017. Clear squares indicate males; filled circles indicate females. The lines (dotted for males, solid for females) represent modelled trends based on joinpoint data.
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Affiliation(s)
- A Hartley
- Imperial College London, London, United Kingdom
| | | | | | - J D Salciccioli
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
| | - I Malik
- Imperial College London, London, United Kingdom
| | - R Y Khamis
- Imperial College London, London, United Kingdom
| | - J Shalhoub
- Imperial College London, London, United Kingdom
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9
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Patel V, Levy S, Malik I, Fertleman MB, Koizia LJ. Takotsubo cardiomyopathy in elderly female trauma patients: a case series. J Med Case Rep 2021; 15:451. [PMID: 34481520 PMCID: PMC8418103 DOI: 10.1186/s13256-021-03056-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy is a syndrome characterized by acute left ventricular wall motion abnormalities leading to left ventricular systolic dysfunction. It remains an important differential diagnosis for acute coronary syndrome. CASE PRESENTATIONS Here we describe three cases of Takotsubo cardiomyopathy occurring in three Caucasian female trauma patients (aged 79, 81, and 82 years old) and the impact on their clinical course. CONCLUSIONS For patients requiring surgical management, delays in the diagnosis of Takotsubo cardiomyopathy may lead to postponement of urgent operative management. This delay in surgery likely impacts on length of hospital stay, leading to an increasing morbidity and mortality.
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Affiliation(s)
- Vishal Patel
- Imperial College Healthcare NHS Trust, London, UK
| | - Shuli Levy
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, London, UK
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust, London, UK
| | - Michael B Fertleman
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, London, UK
| | - Louis J Koizia
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, London, UK.
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10
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Scott M, Malik I. Challenges to the UK medical education during the COVID-19 pandemic. J R Coll Physicians Edinb 2021; 51:118-119. [PMID: 34131663 DOI: 10.4997/jrcpe.2021.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mairi Scott
- Centre of Medical Education, School of Medicine, University of Dundee,
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11
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MacCarthy P, Zaman A, Uren N, Cockburn J, Dorman S, Malik I, Muir D, Ozkor MM, Smith D, Shield S. Minimising permanent pacemaker implantation (PPI) after TAVI. Br J Cardiol 2021; 28:20. [PMID: 35747458 PMCID: PMC8822527 DOI: 10.5837/bjc.2021.020] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Increased demand for transcatheter aortic valve implantation (TAVI) procedures for patients with severe aortic stenosis has not been matched with a proportional increase in available resources in recent years. This article highlights the importance of developing integrated care pathways for TAVI, which incorporate standardised protocols for permanent pacemaker implantation (PPI) to ensure best practice, increase service efficiency and reduce rates of PPI post-TAVI.
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Affiliation(s)
- Philip MacCarthy
- Professor in Cardiology King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, SE5 9RS
| | - Azfar Zaman
- Professor of Cardiology Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle-upon-Tyne, NE7 7DN
| | - Neal Uren
- Professor in Cardiology NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG
| | - James Cockburn
- Consultant Cardiologist Brighton and Sussex University Hospitals NHS Trust, Kemptown, Brighton, BN2 1ES
| | - Stephen Dorman
- Consultant Cardiologist University Hospitals Bristol NHS Foundation Trust, Trust Headquarters, Marlborough Street, Bristol, BS1 3NU
| | - Iqbal Malik
- Consultant Cardiologist Imperial College Healthcare NHS Trust, The Bays, S Wharf Road, Paddington, London, W2 1NY
| | - Douglas Muir
- Consultant Cardiologist South Tees Hospital NHS Foundation Trust, Marton Road, Middlesborough, TS4 3BW
| | - Muhiddin Mick Ozkor
- Consultant Cardiologist Barts Health NHS Trust, The Royal Hospital, Whitechapel Road, London, E1 1BB
| | - David Smith
- Consultant Cardiologist Swansea Bay University Health Board, 1 Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot, SA12 7BR
| | - Sarah Shield
- Principal Healthcare Consultant Wilmington Healthcare, 5th Floor, 10 Whitechapel High Street, London, E1 8QS
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12
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Khawaja SA, Mohan P, Jabbour R, Bampouri T, Bowsher G, Hassan AMM, Huq F, Baghdasaryan L, Wang B, Sethi A, Sen S, Petraco R, Ruparelia N, Nijjer S, Malik I, Foale R, Bellamy M, Kooner J, Rana B, Cole G, Sutaria N, Kanaganayagam G, Nihoyannopoulos P, Fox K, Plymen C, Pabari P, Howard L, Davies R, Haji G, Lo Giudice F, Kanagaratnam P, Anderson J, Chukwuemeka A, Khamis R, Varnava A, Baker CSR, Francis DP, Asaria P, Al-Lamee R, Mikhail GW. COVID-19 and its impact on the cardiovascular system. Open Heart 2021; 8:e001472. [PMID: 33723014 PMCID: PMC7969760 DOI: 10.1136/openhrt-2020-001472] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK. METHODS We retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention. RESULTS Mean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for. CONCLUSION Hypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.
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Affiliation(s)
| | - Poornima Mohan
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Jabbour
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Gemma Bowsher
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Farhan Huq
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Amarjit Sethi
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Sayan Sen
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo Petraco
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Neil Ruparelia
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Iqbal Malik
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Rodney Foale
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Bellamy
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Jaspal Kooner
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Bushra Rana
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Graham Cole
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Nilesh Sutaria
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Kevin Fox
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Carla Plymen
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Punam Pabari
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Luke Howard
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Rachel Davies
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Gulammehdi Haji
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Jon Anderson
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Chukwuemeka
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Ramzi Khamis
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Amanda Varnava
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Perviz Asaria
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Rasha Al-Lamee
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Ghada W Mikhail
- Cardiology, Imperial College Healthcare NHS Trust, London, UK
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13
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Naderi H, Robinson S, Swaans MJ, Bual N, Cheung WS, Reid L, Shun-Shin M, Asaria P, Pabari P, Cole G, Kanaganayagam GS, Sutaria N, Bellamy M, Fox K, Nihoyannopoulos P, Petraco R, Al-Lamee R, Nijjer SS, Sen S, Ruparelia N, Baker C, Mikhail G, Malik I, Khamis R, Varnava A, Francis D, Mayet J, Rana B. Adapting the role of handheld echocardiography during the COVID-19 pandemic: A practical guide. Perfusion 2021; 36:547-558. [PMID: 33427055 DOI: 10.1177/0267659120986532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The COVID-19 pandemic has altered our approach to inpatient echocardiography delivery. There is now a greater focus to address key clinical questions likely to make an immediate impact in management, particularly during the period of widespread infection. Handheld echocardiography (HHE) can be used as a first-line assessment tool, limiting scanning time and exposure to high viral load. This article describes a potential role for HHE during a pandemic. We propose a protocol with a reporting template for a focused core dataset necessary in delivering an acute echocardiography service in the setting of a highly contagious disease, minimising risk to the operator. We cover the scenarios typically encountered in the acute cardiology setting and how an expert trained echocardiography team can identify such pathologies using a limited imaging format and include cardiac presentations encountered in those patients acutely unwell with COVID-19.
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Affiliation(s)
- Hafiz Naderi
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Nina Bual
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Wing-See Cheung
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Laura Reid
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Matthew Shun-Shin
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Perviz Asaria
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Punam Pabari
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Graham Cole
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Gajen S Kanaganayagam
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Nilesh Sutaria
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Michael Bellamy
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Kevin Fox
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | | | - Ricardo Petraco
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rasha Al-Lamee
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sukhjinder S Nijjer
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Sayan Sen
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Neil Ruparelia
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christopher Baker
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Ghada Mikhail
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Iqbal Malik
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Ramzi Khamis
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Amanda Varnava
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Darrel Francis
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jamil Mayet
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Bushra Rana
- Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK
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14
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Seligman H, Sen S, Nijjer S, Al-Lamee R, Clifford P, Sethi A, Hadjiloizou N, Kaprielian R, Ramrakha P, Bellamy M, Khan MA, Kooner J, Foale RA, Mikhail G, Baker CS, Mayet J, Malik I, Khamis R, Francis D, Petraco R. Management of Acute Coronary Syndromes During the Coronavirus Disease 2019 Pandemic: Deviations from Guidelines and Pragmatic Considerations for Patients and Healthcare Workers. ACTA ACUST UNITED AC 2020; 15:e16. [PMID: 33318752 PMCID: PMC7726851 DOI: 10.15420/icr.2020.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is forcing cardiology departments to rapidly adapt existing clinical guidelines to a new reality and this is especially the case for acute coronary syndrome pathways. In this focused review, the authors discuss how COVID-19 is affecting acute cardiology care and propose pragmatic guideline modifications for the diagnosis and management of acute coronary syndrome patients, particularly around the appropriateness of invasive strategies as well as length of hospital stay. The authors also discuss the use of personal protective equipment for healthcare workers in cardiology. Based on shared global experiences and growing peer-reviewed literature, it is possible to put in place modified acute coronary syndrome treatment pathways to offer safe pragmatic decisions to patients and staff.
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Affiliation(s)
- Henry Seligman
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Sayan Sen
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Sukhjinder Nijjer
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Rasha Al-Lamee
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | | | | | | | | | | | | | | | - Jaspal Kooner
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | | | | | | | - Jamil Mayet
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Iqbal Malik
- Imperial College Healthcare NHS Trust London, UK
| | - Ramzi Khamis
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Darrel Francis
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
| | - Ricardo Petraco
- Imperial College Healthcare NHS Trust London, UK.,National Heart and Lung Institute Imperial College London, UK
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15
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Little CD, Kotecha T, Candilio L, Jabbour RJ, Collins GB, Ahmed A, Connolly M, Kanyal R, Demir OM, Lawson LO, Wang B, Firoozi S, Spratt JC, Perera D, MacCarthy P, Dalby M, Jain A, Wilson SJ, Malik I, Rakhit R. COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group. Open Heart 2020; 7:openhrt-2020-001432. [PMID: 33106441 PMCID: PMC7592245 DOI: 10.1136/openhrt-2020-001432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19. Methods We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes Results There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62–118) min in 2020 vs 75 (57–95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34–65) min in 2020 vs 48 (35–70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3–9) days vs 3 (2–4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19. Conclusion These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.
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Affiliation(s)
- Callum D Little
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom .,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Tushar Kotecha
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Luciano Candilio
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Richard J Jabbour
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - George B Collins
- Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
| | - Asrar Ahmed
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Michelle Connolly
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ritesh Kanyal
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ozan M Demir
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Lucy O Lawson
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Brian Wang
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sam Firoozi
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - James C Spratt
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Divaka Perera
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Miles Dalby
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Ajay Jain
- Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
| | - Simon J Wilson
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Iqbal Malik
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Roby Rakhit
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
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16
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Panoulas V, Rathod K, Kain A, Firoozi S, Nevett J, Kalra S, Malik I, Mathur A, Redwood S, MacCarthy P, Wragg A, Jones D, Dalby M. Impact of early (<24h) versus delayed (>24h) intervention in patients with non ST segment elevation myocardial infarction (an observational study of 20882 patients). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In patients presenting with non ST-segment elevation acute coronary syndromes (NSTE-ACS) an invasive approach has been shown to be superior to conservative management.
Purpose
We aimed to investigate the optimal timing of invasive coronary angiography and subsequent intervention.
Methods
We examined the impact ofearly (≤24h) versus delayed (>24h) intervention in a large observational cohort of 20882 consecutive patients with acute NSTE myocardial infarction (NSTEMI) treated with PCI between 2005 and 2015 at 9 tertiary cardiac centers in London (UK) using Cox-regression analysis and propensity matching.
Results
Mean age was 64.5±12.7 years and 26.1% were females. A quarter (27.6%), were treated within 24h.Patients treated within 24h were slightly younger (62.8±12.8 vs. 65.2±12.6, p<0.001), most commonly male (76% vs. 72.9%, p<0.001) and were more frequently ventilated (2.3% vs. 1.4%, p<0.001) and in cardiogenic shock (3.6% vs. 1.4%, p<0.001) with dynamic changes on their ECG (84.5% vs. 76.1% p<0.001). At a median follow up of 4.2 years (interquartile range 1.8 to 7) 17.7% of patients had died. Estimated 5-year survival in patients treated within 24h was 84.6% vs. 81% for those treated >24h following their presentation (p<0.001). This survival benefit remained following adjustment for confounders; HR (delayed vs. early management)1.11 (95% CI 1.003 to 1.23, p=0.046). In the propensity matched cohort of 4356 patients in each group, there remained a trend for higher survival in the early intervention group (p=0.061).
Conclusions
Notwithstanding the limitations of the retrospective design, this real-world cohort of NSTEMI patients suggests that an early intervention (≤24h) may improve mid term survival.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Panoulas
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - K Rathod
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - A Kain
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S Firoozi
- St George's Healthcare NHS Trust, Cardiology, London, United Kingdom
| | - J Nevett
- London Ambulance Service, London, United Kingdom
| | - S Kalra
- Royal Free Hospital, Cardiology, London, United Kingdom
| | - I Malik
- Hammersmith Hospital, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - S Redwood
- St Thomas' Hospital, Cardiology, London, United Kingdom
| | - P.A MacCarthy
- King's College Hospital, Cardiology, London, United Kingdom
| | - A Wragg
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - D Jones
- Barts Health NHS Trust, Cardiology, London, United Kingdom
| | - M.C Dalby
- Harefield Hospital, Interventional cardiology, London, United Kingdom
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17
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Arri S, Myat A, Malik I, Curzen N, Baumbach A, Gunning M, Henderson R, Ludman P, Banning A, Blackman D, Densem C, Stables R, Byrne J, Hildick-Smith D, Redwood S. New onset left bundle branch block after transcatheter aortic valve implantation and the effect on long-term survival – a UK wide experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2607] [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
Introduction
New onset left bundle branch block (LBBB) is the most common conduction disturbance associated with transcatheter aortic valve implantation (TAVI). It has been shown to adversely affect cardiac function and increase re-hospitalisation, although its impact on mortality remains contentious.
Methods
We conducted an observational cohort analysis of all TAVI procedures performed by 13 heart teams in the United Kingdom from inception of their structural programmes until 31st July 2013. The primary outcome was 1-year all-cause mortality. Secondary outcomes included left ventricular ejection fraction (LVEF) at 30 days and need for a post-TAVI permanent pacemaker (PPM).
Results
1785 patients were eligible for inclusion to the study. The primary analysis cohort was composed of 1409 patients with complete electrocardiographic (ECG) data pre- and post-TAVI. Pre-existing LBBB was present in 200 (14.2%) patients. New LBBB occurred in 323 (22.9%) patients post TAVI, which resolved in 99 (7%) patients prior to discharge. A balloon-expandable device was implanted in 968 (69%) patients, whilst 421 (30%) patients received a self-expandable valve. New LBBB was observed in 120 (12.4%) and 192 (45.6%) patients receiving a balloon- or self-expandable prosthesis respectively.
Overall 1-year all-cause mortality post TAVI was 18.7%. New onset LBBB was not associated with an increase in 1-year all-cause mortality (p=0.416). Factors that were associated with mortality included an increasing logistic EuroScore (p=0.05), history of previous balloon aortic valvuloplasty (p=0.001), renal impairment (p=0.003), previous myocardial infarction with pre-existing LBBB (p=0.028) and atrial fibrillation (p=0.039). Lower baseline peak and mean AV gradients were also associated with greater mortality at 1 year (p=0.001), likely reflecting underlying left ventricular dysfunction.
In the majority of patients, LVEF remained unchanged following TAVI. Interestingly, the presence or absence of new onset LBBB did not affect LVEF improvement at 30 days. 10% of patients required a PPM post TAVI. Predictors of PPM included new LBBB (OR 2.6, p<0.001), pre-TAVI left ventricular systolic impairment (OR 1.2, p=0.037), a self-expandable device (p<0.001), and pre-existing RBBB (OR 4.0, p<0.001).
Conclusions
These findings suggest that new onset LBBB post TAVI does not increase mortality at 1 year or adversely affect LVEF at 30 days.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S.S Arri
- Guys and St Thomas Hospital, London, United Kingdom
| | - A Myat
- Royal Sussex County Hospital, Cardiology, Brighton, United Kingdom
| | - I Malik
- Imperial College London, Cardiology, London, United Kingdom
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Cardiology, Southampton, United Kingdom
| | - A Baumbach
- University Hospitals Bristol NHS Foundation Trust, Cardiology, Bristol, United Kingdom
| | - M Gunning
- University Hospitals of North Midlands, Cardiology, Stoke-on-Trent, United Kingdom
| | - R Henderson
- Nottingham University Hospitals NHS Trust, Cardiology, Nottingham, United Kingdom
| | - P Ludman
- University Hospital Birmingham, Cardiology, Birmingham, United Kingdom
| | - A Banning
- Oxford University Hospitals NHS Foundation Trust, Cardiology, Oxford, United Kingdom
| | - D Blackman
- Leeds Teaching Hospitals NHS Trust, Cardiology, Leeds, United Kingdom
| | - C Densem
- Royal Papworth Hospital NHS Foundation Trust, Cardiology, Cambridge, United Kingdom
| | - R Stables
- Liverpool Heart and Chest Hospital, Cardiology, Liverpool, United Kingdom
| | - J Byrne
- King's College Hospital, Cardiology, London, United Kingdom
| | - D Hildick-Smith
- Royal Sussex County Hospital, Cardiology, Brighton, United Kingdom
| | - S.R Redwood
- Guys and St Thomas Hospital, London, United Kingdom
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18
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Rajkumar C, Shun-Shin M, Seligman H, Ahmad Y, Warisawa T, Cook C, Howard J, Amarin L, Nowbar A, Foley M, Assomull R, Keenan N, Sehmi J, Keeble T, Davies J, Tang K, Gerber R, Cole G, O'Kane P, Sharp A, Khamis R, Kanaganayagam G, Petraco R, Ruparelia N, Malik I, Nijjer S, Sen S, Francis D, Al-Lamee R. TCT CONNECT-385 Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease: A Secondary Analysis From ORBITA. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.407] [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: 11/15/2022]
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19
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Myat A, Papachristofi O, Trivedi U, Bapat V, Young C, de Belder A, Cockburn J, Baumbach A, Banning AP, Blackman DJ, MacCarthy P, Mullen M, Muir DF, Nolan J, Zaman A, de Belder M, Cox I, Kovac J, Brecker S, Turner M, Khogali S, Malik I, Redwood S, Prendergast B, Ludman P, Sharples L, Hildick-Smith D. Transcatheter aortic valve implantation via surgical subclavian versus direct aortic access: A United Kingdom analysis. Int J Cardiol 2020; 308:67-72. [PMID: 32247575 DOI: 10.1016/j.ijcard.2020.03.059] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/06/2020] [Accepted: 03/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical subclavian (SC) and direct aortic (DA) access are established alternatives to the default transfemoral route for transcatheter aortic valve implantation (TAVI). We sought to find differences in survival and procedure-related outcomes after SC- versus DA-TAVI. METHODS We performed an observational cohort analysis of cases prospectively uploaded to the UK TAVI registry. To ensure the most contemporaneous comparison, the analysis focused on SC and DA procedures performed from 2013 to 2015. RESULTS Between January 2013 and July 2015, 82 (37%) SC and 142 (63%) DA cases were performed that had validated 1-year life status. Multivariable regression analysis showed procedure duration was longer for SC cases (SC 193.5 ± 65.8 vs. DA 138.4 ± 57.7 min; p < .01) but length of hospital stay was shorter (SC 8.6 ± 9.5 vs. DA 11.9 ± 10.8 days; p = .03). Acute kidney injury was observed less frequently after SC cases (odds ratio [OR] 0.35, 95% confidence interval [CI 0.12-0.96]; p = .042) but vascular access site-related complications were more common (OR 9.75 [3.07-30.93]; p < .01). Procedure-related bleeding (OR 0.54 [0.24-1.25]; p = .15) and in-hospital stroke rate (SC 3.7% vs. DA 2.1%; p = .67) were similar. There were no significant differences in in-hospital (SC 2.4% vs. DA 4.9%; p = .49), 30-day (SC 2.4% vs. DA 4.2%; p = .71) or 1-year (SC 14.5% vs. DA 21.9%; p = .344) mortality. CONCLUSIONS Surgical subclavian and direct aortic approaches can offer favourable outcomes in appropriate patients. Neither access modality conferred a survival advantage but there were significant differences in procedural metrics that might influence which approach is selected.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Olympia Papachristofi
- London School of Hygiene and Tropical Medicine, London, UK; Novartis Pharma AG, Basel, Switzerland
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Vinayak Bapat
- New York-Presbyterian Columbia University Medical Centre, New York, USA; Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Young
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andreas Baumbach
- Queen Mary University of London, London, UK; Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Daniel J Blackman
- Yorkshire Heart Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip MacCarthy
- King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | | | - Douglas F Muir
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - James Nolan
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke, UK
| | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Mark de Belder
- Barts Heart Centre, Barts Health NHS Trust, London, UK; Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Ian Cox
- Department of Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jan Kovac
- Biomedical Research Unit, University of Leicester, Leicester, UK
| | - Stephen Brecker
- Cardiology Clinical Academic Group, St. George's University of London, London, UK
| | - Mark Turner
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Iqbal Malik
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Redwood
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bernard Prendergast
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Linda Sharples
- London School of Hygiene and Tropical Medicine, London, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
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20
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Affiliation(s)
- Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Henry Seligman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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21
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Brogan P, Burns JC, Cornish J, Diwakar V, Eleftheriou D, Gordon JB, Gray HH, Johnson TW, Levin M, Malik I, MacCarthy P, McCormack R, Miller O, Tulloh RMR. Lifetime cardiovascular management of patients with previous Kawasaki disease. Heart 2019; 106:411-420. [PMID: 31843876 PMCID: PMC7057818 DOI: 10.1136/heartjnl-2019-315925] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children. However, many clinicians in the UK are unaware of the disorder and its long-term cardiac complications, potentially leading to late diagnosis, delayed treatment and poorer outcomes. Increasing numbers of patients who suffered KD in childhood are transitioning to the care of adult services where there is significantly less awareness and experience of the condition than in paediatric services. The aim of this document is to provide guidance on the long-term management of patients who have vascular complications of KD and guidance on the emergency management of acute coronary complications. Guidance on the management of acute KD is published elsewhere.
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Affiliation(s)
- Paul Brogan
- Infection, Inflammation, and Rheumatology, UCL Institute of Child Health, London, UK
| | - Jane C Burns
- Pediatrics, University of California, San Diego, California, USA.,Pediatrics, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Jacqueline Cornish
- National Clinical Director Children, Young People and Transition to Adulthood, Medical Directorate, NHS England, London, UK
| | | | - Despina Eleftheriou
- Infection, Inflammation, and Rheumatology, UCL Institute of Child Health, London, UK
| | - John B Gordon
- Cardiology, Sharp Memorial Hospital and San Diego Cardiac Center, San Diego, California, USA
| | | | | | | | - Iqbal Malik
- Imperial College London, International Centre for Circulatory Health, London, UK
| | | | | | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Robert M R Tulloh
- Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Bristol, UK .,University of Bristol, Bristol Heart Institute, Bristol, UK
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22
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Al-Lamee RK, Shun-Shin MJ, Howard JP, Nowbar AN, Rajkumar C, Thompson D, Sen S, Nijjer S, Petraco R, Davies J, Keeble T, Tang K, Malik I, Bual N, Cook C, Ahmad Y, Seligman H, Sharp AS, Gerber R, Talwar S, Assomull R, Cole G, Keenan NG, Kanaganayagam G, Sehmi J, Wensel R, Harrell FE, Mayet J, Thom S, Davies JE, Francis DP. Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease: The Stress Echocardiography-Stratified Analysis of ORBITA. Circulation 2019; 140:1971-1980. [PMID: 31707827 PMCID: PMC6903430 DOI: 10.1161/circulationaha.119.042918] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Dobutamine stress echocardiography is widely used to test for ischemia in patients with stable coronary artery disease. In this analysis, we studied the ability of the prerandomization stress echocardiography score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina). METHODS One hundred eighty-three patients underwent dobutamine stress echocardiography before randomization. The stress echocardiography score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of prerandomization stress echocardiography to predict the placebo-controlled effect of PCI on response variables was tested by using regression modeling. RESULTS At prerandomization, the stress echocardiography score was 1.56±1.77 in the PCI arm (n=98) and 1.61±1.73 in the placebo arm (n=85). There was a detectable interaction between prerandomization stress echocardiography score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echocardiography score (Pinteraction=0.031). With our sample size, we were unable to detect an interaction between stress echocardiography score and any other patient-reported response variables: freedom from angina (Pinteraction=0.116), physical limitation (Pinteraction=0.461), quality of life (Pinteraction=0.689), EuroQOL 5 quality-of-life score (Pinteraction=0.789), or between stress echocardiography score and physician-assessed Canadian Cardiovascular Society angina class (Pinteraction=0.693), and treadmill exercise time (Pinteraction=0.426). CONCLUSIONS The degree of ischemia assessed by dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echocardiography abnormality caused by a stenosis, the greater the reduction in symptoms from PCI. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02062593.
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Affiliation(s)
- Rasha K. Al-Lamee
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Matthew J. Shun-Shin
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Alexandra N. Nowbar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - David Thompson
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - John Davies
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.).,Anglia Ruskin University, Chelmsford, UK (J.D., T.K.)
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, UK (J.D., T.K., K.T.)
| | - Iqbal Malik
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Christopher Cook
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | | | - Robert Gerber
- East Sussex Healthcare NHS Trust, Hastings, UK (R.G.)
| | - Suneel Talwar
- Royal Bournemouth and Christchurch NHS Trust, UK (S. Talwar)
| | - Ravi Assomull
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Graham Cole
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Niall G. Keenan
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Gajen Kanaganayagam
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Joban Sehmi
- West Hertfordshire Hospitals NHS Trust, Watford, UK (N.G.K., J.S.)
| | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Frank E. Harrell
- Vanderbilt University School of Medicine, Department of Biostatistics, Nashville, TN (F.E.H.)
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Simon Thom
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.)
| | - Justin E. Davies
- Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
| | - Darrel P. Francis
- National Heart and Lung Institute, Imperial College London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., D.T., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., G.C., R.W., J.M., S. Thom, D.P.F.).,Imperial College Healthcare NHS Trust, London, UK (R.K.A-L., M.J.S.-S., J.P.H., A.N.N., C.R., S.S., S.N., R.P., I.M., C.C., Y.A., H.S., R.A., G.C., G.K., J.M., J.E.D., D.P.F.)
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23
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Ahmad Y, Vendrik J, Eftekhari A, Howard JP, Cook C, Rajkumar C, Malik I, Mikhail G, Ruparelia N, Hadjiloizou N, Nijjer S, Al-Lamee R, Petraco R, Warisawa T, Wijntjens GWM, Koch KT, van de Hoef T, de Waard G, Echavarria-Pinto M, Frame A, Sutaria N, Kanaganayagam G, Ariff B, Anderson J, Chukwuemeka A, Fertleman M, Koul S, Iglesias JF, Francis D, Mayet J, Serruys P, Davies J, Escaned J, van Royen N, Götberg M, Juhl Terkelsen C, Høj Christiansen E, Piek JJ, Baan J, Sen S. Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow. Circ Cardiovasc Interv 2019; 12:e008263. [PMID: 31752515 PMCID: PMC6924937 DOI: 10.1161/circinterventions.119.008263] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jeroen Vendrik
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Ashkan Eftekhari
- Aarhus University Hospital Skejby, Denmark (A.E., C.J.T., E.H.C.)
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sukhjinder Nijjer
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | | | - Karel T Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Tim van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Guus de Waard
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | | | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Switzerland (J.F.I.)
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
| | - Justin Davies
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.M., G.M., N.R., N.H., S.N., A.F., N.S., G.K., B.A., J.A., A.C., M.F., J.D.)
| | - Javier Escaned
- Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.)
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands (G.d.W., N.v.R.)
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden (S.K., M.G.)
| | | | | | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Jan Baan
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, the Netherlands (J.V., K.T.K., T.v.d.H., J.J.P., J.B.)
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, United Kingdom (Y.A., J.P.H., C.C., C.R., R.A.-L., R.P., T.W., D.F., J.M., P.S., S.S.)
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24
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Beirne A, Rathod K, Jain A, Mathur A, Wragg A, Smith EJ, Jones DA, Kalra S, Malik I, Redwood S, MacCarthy P, Bogle R, Firoozi S, Dalby M. P6516The association between prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention (PCI): an observational study of 123,780 patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Limited information exists regarding procedural success and clinical outcomes in patients with previous CABG undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without previous coronary artery bypass grafts (CABG).
Methods
This was an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry, from January 2005 to December 2015. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (interquartile range 1.2–4.6 years).
Results
12,641 (10.2%) patients had a history of previous CABG, of whom 29.3% (n=3,703) underwent PCI to native vessels and 70.7% (n=8,938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%) (p=0.0005) compared to patients with no history of prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%, p<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (HR 1.02, 95% CI 0.77–1.34; P=0.89) but a significant increase in mortality among patients with PCI to bypass grafts (HR 1.33 95% CI 1.03–1.71, P=0.026). This was seen after multivariate adjustment and propensity matching.
Figure 1. Kaplan-Meier Curves
Conclusion
Patients with prior CABG are older, with a greater comorbid burden and more complex procedural characteristics, but after adjustment for these differences clinical outcomes are similar to patients undergoing PCI without prior CABG. In these patients, native vessel PCI was associated with better outcomes compared to the treatment of vein grafts.
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Affiliation(s)
- A Beirne
- Barts Health NHS Trust, London, United Kingdom
| | - K Rathod
- Barts Health NHS Trust, London, United Kingdom
| | - A Jain
- Barts Health NHS Trust, London, United Kingdom
| | - A Mathur
- Barts Health NHS Trust, London, United Kingdom
| | - A Wragg
- Barts Health NHS Trust, London, United Kingdom
| | - E J Smith
- Barts Health NHS Trust, London, United Kingdom
| | - D A Jones
- Barts Health NHS Trust, London, United Kingdom
| | - S Kalra
- Royal Free Hospital, London, United Kingdom
| | - I Malik
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - S Redwood
- St Thomas' Hospital, London, United Kingdom
| | - P MacCarthy
- Kings College Hospital, London, United Kingdom
| | - R Bogle
- St Georges Hospital, London, United Kingdom
| | - S Firoozi
- St Georges Hospital, London, United Kingdom
| | - M Dalby
- Harefield Hospital, London, United Kingdom
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25
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D'Anna L, Demir O, Banerjee S, Malik I. Intravenous Thrombolysis and Mechanical Thrombectomy in Patients with Stroke after TAVI: A Report of Two Cases. J Stroke Cerebrovasc Dis 2019; 28:104277. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022] Open
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26
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Motwani M, Burley O, Luckie M, Cunnington C, Pisaniello AD, Hasan R, Malik I, Fraser DG. 3D-printing assisted closure of paravalvular leak. J Cardiovasc Comput Tomogr 2019; 14:e66-e68. [PMID: 30930181 DOI: 10.1016/j.jcct.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/01/2019] [Accepted: 03/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Manish Motwani
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK; University of Manchester, Manchester, UK.
| | - Oliver Burley
- Maxillofacial Laboratory Department, North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, UK
| | - Matthew Luckie
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Colin Cunnington
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Anthony D Pisaniello
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Ragheb Hasan
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Iqbal Malik
- Cardiovascular Division, Imperial College Healthcare NHS Trust, London, UK
| | - Douglas G Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
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27
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Ahmad Y, Götberg M, Cook C, Howard JP, Malik I, Mikhail G, Frame A, Petraco R, Rajkumar C, Demir O, Iglesias JF, Bhindi R, Koul S, Hadjiloizou N, Gerber R, Ramrakha P, Ruparelia N, Sutaria N, Kanaganayagam G, Ariff B, Fertleman M, Anderson J, Chukwuemeka A, Francis D, Mayet J, Serruys P, Davies J, Sen S. Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement: Implications for Clinical Indices of Coronary Stenosis Severity. JACC Cardiovasc Interv 2018; 11:2019-2031. [PMID: 30154062 PMCID: PMC6197079 DOI: 10.1016/j.jcin.2018.07.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects: 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve. BACKGROUND A significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied. METHODS Twenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR. RESULTS Flow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s; p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR; p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR; p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR; p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR; p = 0.001). CONCLUSIONS Systolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free period of diastole did not change post-TAVR, suggesting that indices calculated during this period are not vulnerable to the confounding effect of the stenotic aortic valve.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden
| | - Christopher Cook
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - James P Howard
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Iqbal Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ricardo Petraco
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Christopher Rajkumar
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Ozan Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Juan F Iglesias
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Sasha Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Sweden
| | - Nearchos Hadjiloizou
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert Gerber
- Department of Cardiology, Conquest Hospital, St. Leonards-on-Sea, United Kingdom
| | - Punit Ramrakha
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nilesh Sutaria
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gajen Kanaganayagam
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ben Ariff
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jon Anderson
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Andrew Chukwuemeka
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Jamil Mayet
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Patrick Serruys
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Justin Davies
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Sayan Sen
- National Heart and Lung Institute, Hammersmith Hospital, Imperial College London, London, United Kingdom.
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28
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Bak A, Kozik V, Malik I, Jampilek J, Smolinski A. Probability-driven 3D pharmacophore mapping of antimycobacterial potential of hybrid molecules combining phenylcarbamoyloxy and N-arylpiperazine fragments. SAR QSAR Environ Res 2018; 29:801-821. [PMID: 30230355 DOI: 10.1080/1062936x.2018.1517278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
The current study examines in silico characterization of the structure-inhibitory potency for a set of phenylcarbamic acid derivatives containing an N-arylpiperazine scaffold, considering the electronic, steric and lipophilic properties. The main objective of the ligand-based modelling was the systematic study of classical comparative molecular field analysis (CoMFA)/comparative molecular surface analysis (CoMSA) performance for the modelling of in vitro efficiency observed for these phenylcarbamates, revealing their inhibitory activities against a virulent Mycobacterium tuberculosis H37Rv strain. We compared the findings of efficiency modelling produced by a standard 3D methodology (CoMFA) and its neural counterparts (CoMSA) regarding multiple training/test subsets and variables used. Moreover, systematic space inspection, splitting values into the analysed training/test subsets, was performed to monitor statistical estimator performance while mapping the probability-driven pharmacophore pattern. Consequently, a 'pseudo-consensus' 3D-quantitative structure-activity relationship (3D-QSAR) approach was applied to retrieve an 'average' pharmacophore hypothesis by the investigation of the most densely populated training/test subpopulations to specify the potentially important factors contributing to the inhibitory activity of phenylcarbamic acid analogues. In addition, examination of descriptor-based similarity with a principal component analysis (PCA) procedure was employed to visualize noticeable variations in the performance of these molecules with respect to their structure and activity profiles.
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Affiliation(s)
- A Bak
- a Department of Synthesis Chemistry , Institute of Chemistry, University of Silesia , Katowice , Poland
| | - V Kozik
- a Department of Synthesis Chemistry , Institute of Chemistry, University of Silesia , Katowice , Poland
| | - I Malik
- b Department of Pharmaceutical Chemistry, Faculty of Pharmacy , Comenius University , Bratislava , Slovakia
| | - J Jampilek
- b Department of Pharmaceutical Chemistry, Faculty of Pharmacy , Comenius University , Bratislava , Slovakia
| | - A Smolinski
- c Department of Energy Saving and Air Protection , Central Mining Institute , Katowice , Poland
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Cook C, Ahmad Y, Howard J, Shun-Shin M, Sethi A, Clesham G, Tang K, Nijjer S, Kelly P, Davies J, Malik I, Kaprielian R, Mikhail G, Petraco R, Warisawa T, Al-Janabi F, Karamasis G, Gamma R, Al-Lamee R, Keeble T, Mayet J, Sen S, Francis D, Davies J. TCT-96 Predicting angina-limited exercise capacity using coronary physiology. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ahmad Y, Gotberg M, Cook C, Howard J, Malik I, Mikhail G, Francis D, Mayet J, Davies J, Sen S. TCT-9 Coronary pressure and flow in patients with severe aortic stenosis and coronary artery disease undergoing TAVI: implications for clinical indices of coronary stenosis severity. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ahmad Y, Howard J, Arnold A, Shun-Shin M, Cook C, Petraco R, Sutaria N, Malik I, Mayet J, Francis DP, Sen S. P716PFO closure is superior to medical therapy for cryptogenic stroke: a meta-analysis of randomised controlled trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Ahmad
- Imperial College London, London, United Kingdom
| | - J Howard
- Imperial College London, London, United Kingdom
| | - A Arnold
- Imperial College London, London, United Kingdom
| | - M Shun-Shin
- Imperial College London, London, United Kingdom
| | - C Cook
- Imperial College London, London, United Kingdom
| | - R Petraco
- Imperial College London, London, United Kingdom
| | - N Sutaria
- Imperial College NHS Healthcare Trust, Cardiolog, London, United Kingdom
| | - I Malik
- City Hospital Birmingham, University of Birmingham Centre for Cardiovascular Medicine, Birmingham, United Kingdom
| | - J Mayet
- Imperial College London, London, United Kingdom
| | - D P Francis
- Imperial College London, London, United Kingdom
| | - S Sen
- Imperial College London, London, United Kingdom
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Ahmad Y, Howard JP, Arnold A, Shin MS, Cook C, Petraco R, Demir O, Williams L, Iglesias JF, Sutaria N, Malik I, Davies J, Mayet J, Francis D, Sen S. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials. Eur Heart J 2018; 39:1638-1649. [PMID: 29590333 PMCID: PMC5946888 DOI: 10.1093/eurheartj/ehy121] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/09/2017] [Accepted: 02/26/2018] [Indexed: 01/10/2023] Open
Abstract
Aims The efficacy of patent foramen ovale (PFO) closure for cryptogenic stroke has been controversial. We undertook a meta-analysis of randomized controlled trials (RCTs) comparing device closure with medical therapy to prevent recurrent stroke for patients with PFO. Methods and results We systematically identified all RCTs comparing device closure to medical therapy for cryptogenic stroke in patients with PFO. The primary efficacy endpoint was recurrent stroke, analysed on an intention-to-treat basis. The primary safety endpoint was new onset atrial fibrillation (AF). Five studies (3440 patients) were included. In all, 1829 patients were randomized to device closure and 1611 to medical therapy. Across all patients, PFO closure was superior to medical therapy for prevention of stroke [hazard ratio (HR) 0.32, 95% confidence interval (95% CI) 0.13-0.82; P = 0.018, I2 = 73.4%]. The risk of AF was significantly increased with device closure [risk ratio (RR) 4.68, 95% CI 2.19-10.00, P<0.001, heterogeneity I2 = 27.5%)]. In patients with large shunts, PFO closure was associated with a significant reduction in stroke (HR 0.33, 95% CI 0.16-0.72; P = 0.005), whilst there was no significant reduction in stroke in patients with a small shunt (HR 0.90, 95% CI 0.50-1.60; P = 0.712). There was no effect from the presence or absence of an atrial septal aneurysm on outcomes (P = 0.994). Conclusion In selected patients with cryptogenic stroke, PFO closure is superior to medical therapy for the prevention of further stroke: this is particularly true for patients with moderate-to-large shunts. Guidelines should be updated to reflect this.
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Affiliation(s)
- Yousif Ahmad
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - James P Howard
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Ahran Arnold
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Matthew Shun Shin
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Christopher Cook
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Ricardo Petraco
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Ozan Demir
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Luke Williams
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Juan F Iglesias
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Nilesh Sutaria
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Iqbal Malik
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Justin Davies
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Jamil Mayet
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Darrel Francis
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
| | - Sayan Sen
- National Heart and Lung Institute, 2nd Floor B Block, Hammersmith Hospital, Imperial College London W12 0HS, UK
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Ahmad Y, Demir O, Rajkumar C, Howard JP, Shun-Shin M, Cook C, Petraco R, Jabbour R, Arnold A, Frame A, Sutaria N, Ariff B, Kanaganayagam G, Francis D, Mayet J, Mikhail G, Malik I, Sen S. Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis. Open Heart 2018; 5:e000748. [PMID: 29387433 PMCID: PMC5786926 DOI: 10.1136/openhrt-2017-000748] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/13/2017] [Accepted: 12/29/2017] [Indexed: 01/09/2023] Open
Abstract
Objective International guidelines recommend the use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The recommended duration of DAPT varies between guidelines. In this two-part study, we (1) performed a structured survey of 45 TAVI centres from around the world to determine if there is consensus among clinicians regarding antiplatelet therapy after TAVI; and then (2) performed a systematic review of all suitable studies (randomised controlled trials (RCTs) and registries) to determine if aspirin monotherapy can be used instead of DAPT. Methods A structured electronic survey regarding antiplatelet use after TAVI was completed by 45 TAVI centres across Europe, Australasia and the USA. A systematic review of TAVI RCTs and registries was then performed comparing DAPT duration and incidence of stroke, bleeding and death. A variance weighted least squared metaregression was then performed to determine the relationship of antiplatelet therapy and adverse events. Results 82.2% of centres routinely used DAPT after TAVI. Median duration was 3 months. 13.3% based their practice on guidelines. 11 781 patients (26 studies) were eligible for the metaregression. There was no benefit of DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or bleeding (P=0.91). Discussion Aspirin monotherapy appears to be as safe and effective as DAPT after TAVI.
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Affiliation(s)
- Yousif Ahmad
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ozan Demir
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Christopher Rajkumar
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - James P Howard
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Matthew Shun-Shin
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Christopher Cook
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ricardo Petraco
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Richard Jabbour
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ahran Arnold
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Angela Frame
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Nilesh Sutaria
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ben Ariff
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Gajen Kanaganayagam
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Darrel Francis
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Jamil Mayet
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Ghada Mikhail
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Iqbal Malik
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
| | - Sayan Sen
- International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
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Ahmad Y, Demir O, Howard J, Shun-Shin M, Cook C, Petraco R, Al-Lamee R, Jabbour R, Sutaria N, Ariff B, Kanaganayagam G, Chukwuemeka A, Anderson J, Francis D, Mayet J, Davies J, Mikhail G, Malik I, Sen S. TCT-120 Aspirin is equivalent to dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of 11,781 patients. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Panoulas VF, Demir OM, Ruparelia N, Malik I. Longitudinal deformation of a third generation zotarolimus eluting stent: “The concertina returns!”. World J Cardiol 2017; 9:60-64. [PMID: 28163838 PMCID: PMC5253196 DOI: 10.4330/wjc.v9.i1.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/15/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
In the current case series we describe two cases of longitudinal stent deformation in ostial lesions treated with a new generation zotarolimus eluting stent and review current literature on longitudinal stent deformation. Historically not a common occurrence, longitudinal deformation occurred mainly in Promus Element everolimus eluting stents, which had only two rather than the commonly used 3 links between stent rings. Longitudinal deformation commonly occurs secondary to compression of the proximal edge of the stent by either the guide catheters, or intravascular balloons and imaging catheters. The degree of deformation however, depends on the longitudinal strength and design of the stent.
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Ghosh AK, Mak SM, Ahmad Y, Malik I, Nihoyannopoulos P, Gopalan D. Congenital epicardial coronary artery to bilateral internal mammary artery fistulae. BJR Case Rep 2016; 2:20160014. [PMID: 30363836 PMCID: PMC6183205 DOI: 10.1259/bjrcr.20160014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022] Open
Abstract
A 39-year-old male ex-smoker gave a history of exertional chest pain ever since he suffered a respiratory tract infection. Clinical examination, electrocardiogram and echocardiography were normal and he was referred for a cardiac CT scan to assess coronary artery calcification and patency. The scan demonstrated incidental fistulae between the right internal mammary artery and the right coronary artery, and the left internal mammary artery and the left anterior descending artery.
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37
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Ahmad Y, Cook C, Petraco R, Nijjer S, Al-Lamee R, Shun-Shin M, Keene D, Balu A, Malik I, Baker C, Mikhail G, Sethi A, Foale R, Davies J, Mayet J, Francis D, Sen S. 97 Multi-vessel Angioplasty at the Time of STEMI has Equivalent Mortality to a Culprit Only Strategy: Resolving The Paradox of Randomised Controlled Trials and Observational Studies in Multivessel Disease and STEMI. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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38
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Ahmad Y, Sen S, Nijjer S, Keene D, Cook C, Petraco R, Shun-Shin M, Cole G, Al-Lamee R, Malik I, Baker C, Mikhail G, Foale R, Mayet J, Davies J, Francis D. 35 Thrombus Aspiration does not Reduce Mortality in STEMI Patients: A Meta-Analysis of 20,192 Patients, with Implications for Future Trial Design. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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39
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Mattle HP, Evers S, Hildick-Smith D, Becker WJ, Baumgartner H, Chataway J, Gawel M, Göbel H, Heinze A, Horlick E, Malik I, Ray S, Zermansky A, Findling O, Windecker S, Meier B. Percutaneous closure of patent foramen ovale in migraine with aura, a randomized controlled trial. Eur Heart J 2016; 37:2029-36. [PMID: 26908949 DOI: 10.1093/eurheartj/ehw027] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [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: 12/28/2015] [Accepted: 01/20/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Migraine with aura and patent foramen ovale (PFO) are associated. The Percutaneous Closure of PFO in Migraine with Aura (PRIMA) trial is a multicentre, randomized trial to investigate the effect of percutaneous PFO closure in patients refractory to medical treatment. METHODS Migraine with aura patients and PFO who were unresponsive to preventive medications were randomized to PFO closure or medical treatment. Both groups were given acetylsalicylic acid 75-100 mg/day for 6 months and clopidogrel 75 mg/day for 3 months. The primary endpoint was reduction in monthly migraine days during months 9-12 after randomization compared with a 3-month baseline phase before randomization. The committee reviewing the headache diaries were blinded to treatment assignment. RESULTS One hundred and seven patients were randomly allocated to treatment with an Amplatzer PFO Occluder (N = 53) or control with medical management (N = 54). The trial was terminated prematurely because of slow enrolment. Eighty-three patients (40 occluder, 43 control) completed 12-month follow-up. Mean migraine days at baseline were 8 (±4.7 SD) in the closure group and 8.3 (±2.4) in controls. The primary endpoint was negative with -2.9 days after PFO closure vs. -1.7 days in control group (P = 0.17). Patent foramen ovale closure caused five adverse events without permanent sequelae. CONCLUSION In patients with refractory migraine with aura and PFO, PFO closure did not reduce overall monthly migraine days.
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Affiliation(s)
- Heinrich P Mattle
- Department of Neurology, Bern University Hospital, Bern 3010, Switzerland
| | - Stefan Evers
- University Hospital of Münster, Münster, Germany
| | | | - Werner J Becker
- Hotchkiss Brain Institute, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | | | - Jeremy Chataway
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Marek Gawel
- Davisville Medical Centre, Toronto, ON, Canada
| | | | - Axel Heinze
- Kiel Migraine and Headache Centre, Kiel, Germany
| | | | - Iqbal Malik
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Simon Ray
- University Hospitals of South Manchester, Manchester, UK
| | | | - Oliver Findling
- Department of Neurology, Bern University Hospital, Bern 3010, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
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Sanusi T, Davis J, Nicassio N, Malik I. Endoscopic lumbar discectomy under local anesthesia may be an alternative to microdiscectomy: A single centre's experience using the far lateral approach. Clin Neurol Neurosurg 2015; 139:324-7. [PMID: 26583835 DOI: 10.1016/j.clineuro.2015.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 03/10/2015] [Revised: 09/16/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Since the turn of the century, minimally invasive surgery has become increasingly widespread. Discectomy surgery has evolved from wide open to microscopic and now endoscopic. This study aims to demonstrate that transforaminal endoscopic discectomy is an alternative and safe approach for degenerative disk surgery. PATIENTS AND METHODS Two year retrospective assessments of patients who underwent transforaminal endoscopic discectomy at a tertiary neurosurgical center in the United Kingdom by a single surgeon. Under strict confidentiality, data was collected from online patient data and PACS systems. Patient feedback was achieved using phone call follow up and clinic appointments. Standard statistical analysis was performed. RESULTS 201 patients had endoscopic discectomy and the mean age was 41 years. Male:female ratio was 1.3:1.0. Mean time of onset of symptoms was 5.5 months and the most common level was L4/5 (53%). All endoscopic discectomies were performed under local anesthesia. Theater time was on average 110 min. 10 patients were lost to follow up. 95% of patients were discharged within 7h post operatively. Visual acuity score of the pain dropped from an average of 7/10 pre-operatively to 0-1/10 in 95% of patients two weeks post operatively. 87% patients went back to their normal daily activities within two weeks. There were no cases of CSF leak, hematoma formation or wound infection. 1% of patients developed a nerve root injury. 6% of patients had recurrent herniation and require microdiscectomy. CONCLUSION Endoscopic discectomy can be an alternative approach to microdiscectomy. While it can take more expertise to perform endoscopic discectomy, our data shows that the far lateral endoscopic discectomy using the TESSYS technique has comparable outcomes to microdiscectomy.
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Affiliation(s)
- T Sanusi
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - J Davis
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
| | - N Nicassio
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - I Malik
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
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Nijjer S, Sen S, Petraco R, Al-Lamee R, Broyd C, Mayet J, Francis D, Davies J, Mikhail G, Malik I. 105 Virtual PCI with iFR-Pullback in Complex Coronary Disease: The Potential for Reducing Stent Length. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Nijjer S, Sen S, Davies J, Petraco R, Al-Lamee R, Broyd C, Mikhail G, Malik I, Mayet J, Francis D. 106 Virtual-PCI With iFR-Pullback can Plan Coronary Intervention in Complex Coronary Disease with a Prediction of Functional Gain. Heart 2015. [DOI: 10.1136/heartjnl-2015-308066.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Costopoulos C, Sutaria N, Ariff B, Fertleman M, Malik I, Mikhail GW. Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation. Expert Rev Cardiovasc Ther 2015; 13:457-60. [PMID: 25865236 DOI: 10.1586/14779072.2015.1036742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care.
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Affiliation(s)
- Charis Costopoulos
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
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44
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Broyd C, Nijjer S, Sen S, Petraco R, Al-Lamee R, Foin N, Al-Bastami M, Sethi A, Kaprielian R, Malik I, Francis D, Parker K, Hughes A, Mikhail GW, Mayet J, Davies J. CRT-706 Development Of Non-invasive Coronary Wave Intensity Analysis. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Higgins P, Malik I, Ghosh S. 33 * IMPROVED DOCUMENTATION OF DELIRIUM AND CAPACITY ASSESSMENTS IN THE MEDICAL RECEIVING UNIT. Age Ageing 2014. [DOI: 10.1093/ageing/afu124.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ramtoola S, Jude E, Robinson A, Malik I, Rayman G, Dang C, RossMartin GD, Ali A. A study of patient experience using a blood glucose meter with an in-built insulin dose calculator. J Diabetes Sci Technol 2014; 8:776-82. [PMID: 24876430 PMCID: PMC4764205 DOI: 10.1177/1932296814532489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurate calculation and adjustment of insulin doses is integral to maintaining glycemic control in insulin treated patients. Difficulties with insulin dose calculations may lead to poor adherence to blood glucose monitoring and insulin treatment regimes, resulting in poor metabolic control. The main objective of this study was to evaluate ease of use and user preference of a high specification touch screen blood glucose meter, which has an in-built insulin calculator, compared to patients' usual method of testing blood glucose and deciding insulin doses. Patients with diabetes on a multiple daily injection insulin regime used the Test Meter without the insulin calculator and 1 of 3 comparator meters, each for a 7-day period. They then used the Test Meter with the in-built calculator for 10 days. Patients completed an ease of use questionnaire after each 7-day period, a preference questionnaire after the second 7-day period, and a questionnaire comparing the Test Meter with their usual method after the final 10-day period. Of 164 patients who completed the study, 76% stated a preference for the Test Meter as a diabetes management tool compared to their usual method. A small number of patients preferred familiar methods and/or calculating insulin doses themselves. The log book function of meters was important to most patients. The Test Meter system with in-built insulin calculator supports people to better manage their diabetes and increases their confidence. Patients have different needs and preferences which should be acknowledged and supported in a patient centered health service.
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Affiliation(s)
| | - Edward Jude
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | | | | | - Cuong Dang
- University of Salford Diabetes Centre, North Manchester General Hospital, Manchester, UK
| | | | - Amar Ali
- Royal Blackburn Hospital, Blackburn, UK
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Calvert PA, Cockburn J, Wynne D, Ludman P, Rana BS, Northridge D, Mullen MJ, Malik I, Turner M, Khogali S, Veldtman GR, Been M, Butler R, Thomson J, Byrne J, MacCarthy P, Morrison L, Shapiro LM, Bridgewater B, de Giovanni J, Hildick-Smith D. Percutaneous Closure of Postinfarction Ventricular Septal Defect. Circulation 2014; 129:2395-402. [DOI: 10.1161/circulationaha.113.005839] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background—
Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative.
Methods and Results—
Postinfarction ventricular septal defect closure was attempted in 53 patients from 11 centers (1997–2012; aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction was anterior (66%) or inferior (34%). Time from myocardial infarction to closure procedure was 13 (first and third quartiles, 5–54) days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (23%), partial (62%), or none (15%). Median length of stay after the procedure was 5.0 (2.0–9.0) days. Fifty-eight percent survived to discharge and were followed up for 395 (63–1522) days, during which time 4 additional patients died (7.5%). Factors associated with death after postinfarction ventricular septal defect closure included the following: age (hazard ratio [HR]=1.04;
P
=0.039), female sex (HR=2.33;
P
=0.043), New York Heart Association class IV (HR=4.42;
P
=0.002), cardiogenic shock (HR=3.75;
P
=0.003), creatinine (HR=1.007;
P
=0.003), defect size (HR=1.09;
P
=0.026), inotropes (HR=4.18;
P
=0.005), and absence of revascularization therapy for presenting myocardial infarction (HR=3.28;
P
=0.009). Prior surgical closure (HR=0.12;
P
=0.040) and immediate shunt reduction (HR=0.49;
P
=0.037) were associated with survival.
Conclusions—
Percutaneous closure of postinfarction ventricular septal defect is a reasonably effective treatment for these extremely high-risk patients. Mortality remains high, but patients who survive to discharge do well in the longer term.
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Affiliation(s)
- Patrick A. Calvert
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - James Cockburn
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Dylan Wynne
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Peter Ludman
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Bushra S. Rana
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - David Northridge
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Michael J. Mullen
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Iqbal Malik
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Mark Turner
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Saib Khogali
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Gruschen R. Veldtman
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Martin Been
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Rob Butler
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - John Thomson
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Jonathan Byrne
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Philip MacCarthy
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Lindsay Morrison
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Len M. Shapiro
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Ben Bridgewater
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - Jo de Giovanni
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
| | - David Hildick-Smith
- From the University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, UK (P.A.C., P.L., J.d.G.); University of Cambridge, Cambridge, UK (P.A.C.); Papworth Hospital National Health Service Foundation Trust, Cambridge, UK (P.A.C., B.S.R., L.M.S.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (J.C., D.W., D.H.-S.); Edinburgh Royal Infirmary, Edinburgh, UK (D.N.); The Heart Hospital, University College London, London, UK (M.J.M.); Imperial
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48
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Tempe DK, Malik I. Why do we not toe the line drawn by the National Institute for Clinical Excellence for internal jugular vein cannulation? Br J Anaesth 2014; 113:344-5. [PMID: 24875661 DOI: 10.1093/bja/aeu146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D K Tempe
- Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Jawaharlal Nehru Road, New Delhi 110002, India Maulana Azad Medical College and Associated GB Pant, Loknayak and GNEC Hospitals, New Delhi, India
| | - I Malik
- Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Jawaharlal Nehru Road, New Delhi 110002, India
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49
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Hussain M, Thai Hung N, Abbas N, Khera RA, Malik I, Patonay T, Kelzhanova N, Abilov ZA, Villinger A, Langer P. Synthesis of Arylated Benzofurans by RegioselectiveSuzuki-Miyaura Cross-Coupling Reactions of 2,3-Dibromobenzofurans- and 2,3,5-Tribromobenzofurans. J Heterocycl Chem 2014. [DOI: 10.1002/jhet.2083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Hussain
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
| | - N. Thai Hung
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
| | - N. Abbas
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
- Department of Chemistry; University of Gujrat; Gujrat 50700 Pakistan
| | - R. A. Khera
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
- Department of Chemistry and Biochemistry; University of Agriculture; Faisalabad 38040 Pakistan
| | - I. Malik
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
- Department of Chemistry, COMSATS; Institute of Information Technology; Abbottabad 22060 Khyber Pakhtunkhwa Pakistan
| | - T. Patonay
- Department of Organic Chemistry; University of Debrecen; H-4032 Debrecen Egyetem tér 1 Hungary
| | - N. Kelzhanova
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
- Al-Farabi Kazakh National University; Al-Farabi ave. 71 050040 Almaty Kazakhstan
| | - Z. A. Abilov
- Al-Farabi Kazakh National University; Al-Farabi ave. 71 050040 Almaty Kazakhstan
| | - A. Villinger
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
| | - P. Langer
- Institut für Chemie; Universität Rostock; Albert Einstein Street 3a 18059 Rostock Germany
- Leibniz-Institut für Katalyse an der Universität Rostock e.V; Albert Einstein Street 29a 18059 Rostock Germany
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50
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Nijjer SS, van de Hoef T, da Cunha RP, Sen S, Meuwissen M, Foale RA, Van Lavieren M, Echavarria-Pinto M, Malik I, Mikhail G, Hughes A, Francis D, Mayet J, Escaned J, Di Mario C, Piek J, Davies J. RESTING CORONARY BLOOD FLOW VELOCITY IS CONSTANT ACROSS ALL STENOSIS SEVERITIES: IMPLICATIONS FOR TANDEM LESION AND PULLBACK ASSESSMENT. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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