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Shah B, Smilowitz NR, Xia Y, Feit F, Katz SD, Zhong J, Cronstein B, Lorin JD, Pillinger MH. Major Adverse Cardiovascular Events After Colchicine Administration Before Percutaneous Coronary Intervention: Follow-Up of the Colchicine-PCI Trial. Am J Cardiol 2023; 204:26-28. [PMID: 37536200 PMCID: PMC10947505 DOI: 10.1016/j.amjcard.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
Periprocedural inflammation is associated with major adverse cardiovascular events in patients who undergo percutaneous coronary intervention (PCI). In the contemporary era, 5% to 10% of patients develop restenosis, and in the acute coronary syndrome cohort, there remains a 20% major adverse cardiovascular events rate at 3 years, half of which are culprit-lesion related. In patients at risk of restenosis, colchicine has been shown to reduce restenosis when started within 24 hours of PCI and continued for 6 months thereafter, compared with placebo. The Colchicine-PCI trial, which randomized patients to a 1-time loading dose of colchicine or placebo 1 to 2 hours before PCI, showed a dampening of the inflammatory response to PCI but no difference in postprocedural myocardial injury. On mean follow-up of 3.3 years, the incidence of major adverse cardiovascular events did not differ between colchicine and placebo groups (32.5% vs 34.9%; hazard ratio 0.95 [0.68 to 1.34]).
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Affiliation(s)
- Binita Shah
- Department of Medicine (Cardiology), Veterans Affairs New York Harbor Health Care System, New York, New York; Department of Medicine (Cardiology), New York University School of Medicine, New York, New York.
| | - Nathaniel R Smilowitz
- Department of Medicine (Cardiology), Veterans Affairs New York Harbor Health Care System, New York, New York; Department of Medicine (Cardiology), New York University School of Medicine, New York, New York
| | - Yuhe Xia
- Department of Population Health (Biostatistics), New York University School of Medicine, New York, New York
| | - Frederick Feit
- Department of Medicine (Cardiology), New York University School of Medicine, New York, New York
| | - Stuart D Katz
- Department of Medicine (Cardiology), New York University School of Medicine, New York, New York
| | - Judy Zhong
- Department of Population Health (Biostatistics), New York University School of Medicine, New York, New York
| | - Bruce Cronstein
- Department of Medicine (Rheumatology), New York University School of Medicine, New York, New York
| | - Jeffrey D Lorin
- Department of Medicine (Cardiology), Veterans Affairs New York Harbor Health Care System, New York, New York; Department of Medicine (Cardiology), New York University School of Medicine, New York, New York
| | - Michael H Pillinger
- Department of Medicine (Rheumatology), New York University School of Medicine, New York, New York; Department of Medicine (Rheumatology), Veterans Affairs New York Harbor Health Care System, New York, New York
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Pusic MV, Cook DA, Friedman JL, Lorin JD, Rosenzweig BP, Tong CK, Smith S, Lineberry M, Hatala R. Modeling Diagnostic Expertise in Cases of Irreducible Uncertainty: The Decision-Aligned Response Model. Acad Med 2023; 98:88-97. [PMID: 36576770 PMCID: PMC9780042 DOI: 10.1097/acm.0000000000004918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Assessing expertise using psychometric models usually yields a measure of ability that is difficult to generalize to the complexity of diagnoses in clinical practice. However, using an item response modeling framework, it is possible to create a decision-aligned response model that captures a clinician's decision-making behavior on a continuous scale that fully represents competing diagnostic possibilities. In this proof-of-concept study, the authors demonstrate the necessary statistical conceptualization of this model using a specific electrocardiogram (ECG) example. METHOD The authors collected a range of ECGs with elevated ST segments due to either ST-elevation myocardial infarction (STEMI) or pericarditis. Based on pilot data, 20 ECGs were chosen to represent a continuum from "definitely STEMI" to "definitely pericarditis," including intermediate cases in which the diagnosis was intentionally unclear. Emergency medicine and cardiology physicians rated these ECGs on a 5-point scale ("definitely STEMI" to "definitely pericarditis"). The authors analyzed these ratings using a graded response model showing the degree to which each participant could separate the ECGs along the diagnostic continuum. The authors compared these metrics with the discharge diagnoses noted on chart review. RESULTS Thirty-seven participants rated the ECGs. As desired, the ECGs represented a range of phenotypes, including cases where participants were uncertain in their diagnosis. The response model showed that participants varied both in their propensity to diagnose one condition over another and in where they placed the thresholds between the 5 diagnostic categories. The most capable participants were able to meaningfully use all categories, with precise thresholds between categories. CONCLUSIONS The authors present a decision-aligned response model that demonstrates the confusability of a particular ECG and the skill with which a clinician can distinguish 2 diagnoses along a continuum of confusability. These results have broad implications for testing and for learning to manage uncertainty in diagnosis.
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Affiliation(s)
- Martin V. Pusic
- M.V. Pusic is associate professor of emergency medicine, Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5236-6598
| | - David A. Cook
- D.A. Cook is professor of medicine and medical education, chair, Mayo Clinic Multidisciplinary Simulation Center Research Committee, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - Julie L. Friedman
- J.L. Friedman is assistant professor of clinical medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Jeffrey D. Lorin
- J.D. Lorin is assistant professor, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Barry P. Rosenzweig
- B.P. Rosenzweig is associate professor, Department of Medicine, associate director for educational affairs, Leon H. Charney Division of Cardiology, and assistant dean for graduate medical education, NYU Grossman School of Medicine, New York, New York
| | - Calvin K.W. Tong
- C.K.W. Tong is cardiologist and codirector, Heart Failure Services, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - Silas Smith
- S. Smith is associate professor of emergency medicine, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Matthew Lineberry
- M. Lineberry is associate professor of population health, Department of Population Health, University of Kansas Medical Center and Health System, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-0177-5305
| | - Rose Hatala
- R. Hatala is professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0003-0521-2590
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Tarabanis C, Zhang R, Grossman K, Kaul C, Lorin JD. A case report of Enterobacter cloacae endocarditis in a patient with a history of cotton fever. Eur Heart J Case Rep 2022; 6:ytac258. [PMID: 35911492 PMCID: PMC9336567 DOI: 10.1093/ehjcr/ytac258] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/31/2021] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
Background Cotton fever is a self-limited, febrile syndrome occurring after the injection of trace amounts of drugs, in particular heroin, extracted from reused cotton filters. It is characterized by non-specific findings, such as fever, tachycardia, and leucocytosis. The leading pathophysiologic explanation suggests it is the result of direct inoculation of the bloodstream with endotoxins from Gram-negative bacilli of the genus Enterobacter, known to colonize all parts of the cotton plant. Only one prior case report has suggested cotton fever as a potential risk factor of infective endocarditis (IE). Case summary We describe a case of a 57-year-old patient with a history of intravenous heroin use complicated by self-reported episodes of cotton fever. His presentation was notable for Enterobacter cloacae IE with bilateral septic pulmonary emboli. Transthoracic echocardiography findings included new tricuspid regurgitation and two mobile echodensities on the right atrial implantable cardioverter defibrillator (ICD) lead. Despite broad antibiotic coverage and extraction of the ICD leads, the patient passed away from septic shock. Discussion The present case report is only the second published report of endocarditis in a patient with a history of cotton fever. In both cases, bacteria of the Enterobacter genus were isolated in patients’ blood cultures. This evidence supports the endotoxin theory as the leading pathophysiologic explanation for cotton fever and suggests cotton fever as a risk factor for Gram-negative IE. In the inpatient setting it informs proper antibiotic coverage, whereas in the outpatient setting it supports harm reduction interventions in the form of sterile cotton balls.
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Affiliation(s)
- Constantine Tarabanis
- Department of Medicine, NYU Langone Health , 550 1st Avenue , New York, NY 10016, USA
| | - Ruina Zhang
- Department of Medicine, NYU Langone Health , 550 1st Avenue , New York, NY 10016, USA
| | - Kelsey Grossman
- Division of Cardiology, Veterans Affairs New York Harbor Healthcare System , New York, NY 10016 , USA
| | - Christina Kaul
- Division of Infectious Diseases & Immunology, Department of Medicine, NYU Langone Health , New York, NY 10016 , USA
| | - Jeffrey D Lorin
- Division of Cardiology, Veterans Affairs New York Harbor Healthcare System , New York, NY 10016 , USA
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Adelsheimer A, Shah B, Choy-Shan A, Tenner CT, Lorin JD, Smilowitz NR, Pike VC, Pillinger MH, Donnino R. Gout and Progression of Aortic Stenosis. Am J Med 2020; 133:1095-1100.e1. [PMID: 32081657 PMCID: PMC7429243 DOI: 10.1016/j.amjmed.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with aortic stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without aortic valve disease. METHODS This retrospective study evaluated consecutive adults age ≥65 years with aortic stenosis between December 2012 and November 2016 who underwent at least 2 transthoracic echocardiograms (TTEs) separated by at least 1 year. Severe aortic stenosis was defined as any combination of an aortic valve peak velocity ≥4.0 m/sec, mean gradient ≥40 mm Hg, aortic valve area ≤1 cm2, or decrease in left ventricular ejection fraction as a result of aortic stenosis. RESULTS Of the 699 study patients, gout was present in 73 patients (10%) and not found in 626 patients (90%). Median follow-up was 903 days [552-1302] for patients with gout and 915 days [601-1303] for patients without gout (P = 0.60). The presence of severe aortic stenosis on follow-up transthoracic echocardiogram was more frequent in patients with gout compared to those without gout (74% vs 54%, P = 0.001; hazard ratio [HR] 1.45 [1.09-1.93]), even among the 502 patients without severe aortic stenosis at baseline (63% vs 39%, P = 0.003; hazard ratio 1.43 [1.07-1.91]). Gout remained associated with the development of severe aortic stenosis after multivariable adjustment (adjusted hazard ratio [aHR] 1.46 [1.03-2.08], P = 0.03). The annualized reduction in aortic valve area was numerically greater in the group with gout compared with the group without gout (-0.10 cm2/y [-0.18, -0.03] vs -0.08 cm2/y [-0.16, -0.01], P = 0.09); annualized change in peak velocity and mean gradient did not differ between groups. CONCLUSIONS Progression to severe aortic stenosis was more frequent in patients with gout compared with those without gout, supporting the hypothesis that gout is a risk factor for aortic stenosis.
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Affiliation(s)
| | - Binita Shah
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY.
| | - Alana Choy-Shan
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Craig T Tenner
- Department of Medicine, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Jeffrey D Lorin
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Nathaniel R Smilowitz
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - V Courtney Pike
- Department of Medicine, Division of Rheumatology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Michael H Pillinger
- Department of Medicine, Division of Rheumatology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
| | - Robert Donnino
- Department of Medicine, Division of Cardiology, VA New York Harbor Health Care System and NYU School of Medicine, New York, NY
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Shah B, Pillinger M, Zhong H, Cronstein B, Xia Y, Lorin JD, Smilowitz NR, Feit F, Ratnapala N, Keller NM, Katz SD. Effects of Acute Colchicine Administration Prior to Percutaneous Coronary Intervention: COLCHICINE-PCI Randomized Trial. Circ Cardiovasc Interv 2020; 13:e008717. [PMID: 32295417 DOI: 10.1161/circinterventions.119.008717] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vascular injury and inflammation during percutaneous coronary intervention (PCI) are associated with increased risk of post-PCI adverse outcomes. Colchicine decreases neutrophil recruitment to sites of vascular injury. The anti-inflammatory effects of acute colchicine administration before PCI on subsequent myocardial injury are unknown. METHODS In a prospective, single-site trial, subjects referred for possible PCI (n=714) were randomized to acute preprocedural oral administration of colchicine 1.8 mg or placebo. RESULTS Among the 400 subjects who underwent PCI, the primary outcome of PCI-related myocardial injury did not differ between colchicine (n=206) and placebo (n=194) groups (57.3% versus 64.2%, P=0.19). The composite outcome of death, nonfatal myocardial infarction, and target vessel revascularization at 30 days (11.7% versus 12.9%, P=0.82), and the outcome of PCI-related myocardial infarction defined by the Society for Cardiovascular Angiography and Interventions (2.9% versus 4.7%, P=0.49) did not differ between colchicine and placebo groups. Among 280 PCI subjects in a nested inflammatory biomarker substudy, the primary biomarker end point, change in interleukin-6 concentrations did not differ between groups 1-hour post-PCI but increased less 24 hours post-PCI in the colchicine (n=141) versus placebo group (n=139; 76% [-6 to 898] versus 338% [27 to 1264], P=0.02). High-sensitivity C-reactive protein concentration also increased less after 24 hours in the colchicine versus placebo groups (11% [-14 to 80] versus 66% [1 to 172], P=0.001). CONCLUSIONS Acute preprocedural administration of colchicine attenuated the increase in interleukin-6 and high-sensitivity C-reactive protein concentrations after PCI when compared with placebo but did not lower the risk of PCI-related myocardial injury. Registration: URL: https://www.clinicaltrials.gov; Unique Identifiers: NCT02594111, NCT01709981.
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Affiliation(s)
- Binita Shah
- Section of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S.), VA New York Harbor Health Care System.,Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
| | - Michael Pillinger
- Section of Rheumatology, Department of Medicine (M.P.), VA New York Harbor Health Care System.,Division of Rheumatology, Department of Medicine (M.P., B.C.), New York University School of Medicine
| | - Hua Zhong
- Division of Biostatistics, Department of Population Health (H.Z., Y.X.), New York University School of Medicine
| | - Bruce Cronstein
- Division of Rheumatology, Department of Medicine (M.P., B.C.), New York University School of Medicine
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health (H.Z., Y.X.), New York University School of Medicine
| | - Jeffrey D Lorin
- Section of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S.), VA New York Harbor Health Care System.,Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
| | - Nathaniel R Smilowitz
- Section of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S.), VA New York Harbor Health Care System.,Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
| | - Frederick Feit
- Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
| | - Nicole Ratnapala
- Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
| | - Norma M Keller
- Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
| | - Stuart D Katz
- Division of Cardiology, Department of Medicine (B.S., J.D.L., N.R.S., F.F., N.R., N.M.K., S.D.K.), New York University School of Medicine
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Sedlis SP, Lorin JD. Should Fractional Flow Reserve Be Measured After Stent Deployment? Routinely? Ever? JACC Cardiovasc Interv 2017; 10:996-998. [DOI: 10.1016/j.jcin.2017.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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Chang K, Yokose C, Tenner C, Oh C, Donnino R, Choy-Shan A, Pike VC, Shah BD, Lorin JD, Krasnokutsky S, Sedlis SP, Pillinger MH. Association Between Gout and Aortic Stenosis. Am J Med 2017; 130:230.e1-230.e8. [PMID: 27720853 PMCID: PMC5357081 DOI: 10.1016/j.amjmed.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/14/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. METHODS We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. RESULTS Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). CONCLUSIONS Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications.
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Affiliation(s)
- Kevin Chang
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Chio Yokose
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Craig Tenner
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Primary Care, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Primary Care, Department of Medicine, New York University School of Medicine
| | - Cheongeun Oh
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Department of Biostatistics, New York University
| | - Robert Donnino
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine; Department of Radiology, New York University School of Medicine
| | - Alana Choy-Shan
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Virginia C Pike
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Binita D Shah
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Jeffrey D Lorin
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Svetlana Krasnokutsky
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Steven P Sedlis
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Michael H Pillinger
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine.
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Kinno M, Niazi OT, Lorin JD, Chandrasekaran K. The Importance of Subclavian Angiography in the Evaluation of Chest Pain: Coronary-Subclavian Steal Syndrome. Fed Pract 2017; 34:26-30. [PMID: 30853779 PMCID: PMC6372034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Routine preoperative screening for the presence of brachiocephalic disease using ultrasonic duplex or angiography is a cost-effective and essential means to prevent the development of rare occurrences of coronary-subclavian steal syndrome.
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Affiliation(s)
- Menhel Kinno
- is a physician at the Manhattan Campus of the VA NY Harbor Healthcare System and an assistant professor at New York University School of Medicine, both in New York. is a physician at the East Orange Campus of the VA New Jersey Health Care System in East Orange, New Jersey. and are third-year cardiology fellows at Rutgers New Jersey Medical School in Newark, New Jersey
| | - Osama Tariq Niazi
- is a physician at the Manhattan Campus of the VA NY Harbor Healthcare System and an assistant professor at New York University School of Medicine, both in New York. is a physician at the East Orange Campus of the VA New Jersey Health Care System in East Orange, New Jersey. and are third-year cardiology fellows at Rutgers New Jersey Medical School in Newark, New Jersey
| | - Jeffrey D Lorin
- is a physician at the Manhattan Campus of the VA NY Harbor Healthcare System and an assistant professor at New York University School of Medicine, both in New York. is a physician at the East Orange Campus of the VA New Jersey Health Care System in East Orange, New Jersey. and are third-year cardiology fellows at Rutgers New Jersey Medical School in Newark, New Jersey
| | - Kulandaivelu Chandrasekaran
- is a physician at the Manhattan Campus of the VA NY Harbor Healthcare System and an assistant professor at New York University School of Medicine, both in New York. is a physician at the East Orange Campus of the VA New Jersey Health Care System in East Orange, New Jersey. and are third-year cardiology fellows at Rutgers New Jersey Medical School in Newark, New Jersey
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Sedlis SP, Hartigan PM, Teo KK, Maron DJ, Spertus JA, Mancini GBJ, Kostuk W, Chaitman BR, Berman D, Lorin JD, Dada M, Weintraub WS, Boden WE. Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease. N Engl J Med 2015; 373:1937-46. [PMID: 26559572 PMCID: PMC5656049 DOI: 10.1056/nejmoa1505532] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years. METHODS We obtained permission from the patients at the Department of Veterans Affairs (VA) sites and some non-VA sites in the United States to use their Social Security numbers to track their survival after the original trial period ended. We searched the VA national Corporate Data Warehouse and the National Death Index for survival information and the dates of death from any cause. We calculated survival according to the Kaplan-Meier method and used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics. RESULTS Extended survival information was available for 1211 patients (53% of the original population). The median duration of follow-up for all patients was 6.2 years (range, 0 to 15); the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years (range, 0 to 15). A total of 561 deaths (180 during the follow-up period in the original trial and 381 during the extended follow-up period) occurred: 284 deaths (25%) in the PCI group and 277 (24%) in the medical-therapy group (adjusted hazard ratio, 1.03; 95% confidence interval, 0.83 to 1.21; P=0.76). CONCLUSIONS During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA Cooperative Studies Program and others; COURAGE ClinicalTrials.gov number, NCT00007657.).
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Affiliation(s)
- Steven P Sedlis
- From the New York Veterans Affairs (VA) Healthcare Network, New York (S.P.S., J.D.L.), and Upstate New York VA Healthcare Network and Albany Medical College, Albany (W.E.B.) - all in New York; VA Connecticut Healthcare System, West Haven (P.M.H.) and Hartford Hospital, Hartford (M.D.) - both in Connecticut; McMaster University Medical Center, Hamilton, ON (K.K.T.), Vancouver Hospital and Health Sciences Center, Vancouver, BC (G.B.J.M.), and London Health Sciences Centre, London, ON (W.K.) - all in Canada; Stanford University Medical Center, Stanford, CA (D.J.M.); Mid-America Heart Institute, University of Missouri, Kansas City, Kansas City (J.A.S.); Saint Louis University School of Medicine, St. Louis (B.R.C.); Cedars-Sinai Medical Center, Los Angeles (D.B.); and Christiana Care Health System, Newark, DE (W.S.W.)
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Affiliation(s)
- Steven P Sedlis
- Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY 10010, USA.
| | - Jeffrey D Lorin
- Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY 10010, USA
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Shah B, Berger JS, Amoroso NS, Mai X, Lorin JD, Danoff A, Schwartzbard AZ, Lobach I, Guo Y, Feit F, Slater J, Attubato MJ, Sedlis SP. Periprocedural glycemic control in patients with diabetes mellitus undergoing coronary angiography with possible percutaneous coronary intervention. Am J Cardiol 2014; 113:1474-80. [PMID: 24630791 DOI: 10.1016/j.amjcard.2014.01.428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 12/03/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 12/18/2022]
Abstract
Periprocedural hyperglycemia is an independent predictor of mortality in patients who underwent percutaneous coronary intervention (PCI). However, periprocedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications before coronary angiography with possible PCI on periprocedural glycemic control have not been investigated. Patients with diabetes mellitus (DM; n = 172) were randomized to continue (Continue group; n = 86) or hold (Hold group; n = 86) their clinically prescribed long-acting glucose-lowering medications before the procedure. The primary end point was glucose level on procedural access. In a subset of patients (no DM group: n = 25; Continue group: n = 25; and Hold group: n = 25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97 to 151] vs 134 [117 to 172] mg/dl, p = 0.002). There were two hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2 to 10.4], 8.7% [6.9 to 11.4], 10.9% [8.6 to 14.7], p = 0.007; monocyte platelet aggregates: 14.0% [10.3 to 16.3], 20.8% [16.2 to 27.0], 22.5% [15.2 to 35.4], p <0.001; soluble p-selectin: 51.9 ng/ml [39.7 to 74.0], 59.1 ng/ml [46.8 to 73.2], 72.2 ng/ml [58.4 to 77.4], p = 0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications before coronary angiography with possible PCI help achieve periprocedural euglycemia, appear safe, and should be considered as a strategy for achieving periprocedural glycemic control.
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Affiliation(s)
- Binita Shah
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York.
| | - Jeffrey S Berger
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Division of Hematology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Nicholas S Amoroso
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Xingchen Mai
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Jeffrey D Lorin
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Ann Danoff
- Division of Endocrinology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Arthur Z Schwartzbard
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Iryna Lobach
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Frederick Feit
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - James Slater
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Michael J Attubato
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
| | - Steven P Sedlis
- Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York
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Sedlis SP, Jurkovitz CT, Hartigan PM, Kolm P, Goldfarb DS, Lorin JD, Dada M, Maron DJ, Spertus JA, Mancini GJ, Teo KK, Boden WE, Weintraub WS. Health status and quality of life in patients with stable coronary artery disease and chronic kidney disease treated with optimal medical therapy or percutaneous coronary intervention (post hoc findings from the COURAGE trial). Am J Cardiol 2013; 112:1703-8. [PMID: 24011740 DOI: 10.1016/j.amjcard.2013.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
Chronic kidney disease (CKD) is an important clinical co-morbidity that increases the risk of death and myocardial infarction in patients with coronary artery disease (CAD) even when treated with guideline-directed therapies. It is unknown, however, whether CKD influences the effects of CAD treatments on patients' health status, their symptoms, function, and quality of life. We performed a post hoc analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study to compare health status in patients with stable CAD with and without CKD defined as a glomerular filtration rate of <60 ml/min/1.73 m(2) randomized to either percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or OMT alone. Health status was measured at baseline, 1, 3, 6, 12, 24, and 36 months of follow-up with the Seattle Angina Questionnaire in 310 patients with CKD and 1,719 patients without CKD. Linear mixed-effects models were used to analyze Seattle Angina Questionnaire scores longitudinally. Mean scores for angina-related quality of life, angina frequency, and physical limitation domains improved from baseline values in both patients with and without CKD and plateaued. Early improvement (1 to 6 months) was more common in patients treated with PCI plus OMT than with OMT alone in both patients with and without CKD. Treatment satisfaction scores were high at baseline in all groups and did not change significantly over time. In conclusion, although CKD is an important determinant of event-free survival in patients with stable CAD, it neither precludes satisfactory treatment of angina with PCI plus OMT or OMT alone nor is it associated with an unsatisfactory quality of life.
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Shah B, Sedlis SP, Mai X, Amoroso NS, Guo Y, Lorin JD, Berger JS. Comparison of platelet activity measurements by use of arterial and venous blood sampling. J Thromb Haemost 2013; 11:1922-4. [PMID: 23927560 PMCID: PMC3807126 DOI: 10.1111/jth.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/31/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Binita Shah
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY
| | - Steven P. Sedlis
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY
| | - Xingchen Mai
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY
| | - Nicholas S. Amoroso
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY
| | - Yu Guo
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY
| | - Jeffrey D. Lorin
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY
| | - Jeffrey S. Berger
- Department of Medicine, Divisions of Cardiology and Hematology, New York University School of Medicine, New York, NY
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Miller LH, Toklu B, Rauch J, Lorin JD, Lobach I, Sedlis SP. Very long-term clinical follow-up after fractional flow reserve-guided coronary revascularization. J Invasive Cardiol 2012; 24:309-315. [PMID: 22781467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Randomized trials using measurement of fractional flow reserve (FFR) to guide percutaneous coronary intervention (PCI) have demonstrated both safety and efficacy with regard to cardiac events. Real-world, long-term outcomes using an FFR-based revascularization strategy are unknown. METHODS Prospective clinical data were collected on consecutive patients referred for coronary angiography and found to have lesions of intermediate severity where the operators were unable to make a decision regarding revascularization based on angiographic, clinical, and stress testing parameters. FFR was measured on intermediate lesions, and revascularization was deferred on those lesions with a measurement >0.8. Clinical outcomes of interest included death, myocardial infarction, and late revascularization status. RESULTS A total of 151 patients were included in this study. Fifty-seven patients (37.7%) underwent revascularization based on their FFR measurement. The mean length of follow-up was 6.1 years (range, 5-10 years). Follow-up was completed in 97.0%. At the end of the follow-up period, 107 patients (70.9%) were alive. Late revascularization had been performed in 18 patients (11.9%). Comparing the initial revascularization group with the group in which revascularization was deferred, 64.9% and 74.5% were alive, respectively (P=.29). Of the initial revascularization group, 12.3% had undergone late revascularization of the lesion on which FFR was originally performed, compared with 11.7% in the deferred group (P=.99). CONCLUSIONS FFR is a useful adjunct to coronary angiography in selecting patients with lesions of intermediate angiographic severity in whom coronary revascularization may be safely deferred.
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Affiliation(s)
- Louis H Miller
- VA New York Harbor Health Care System New York Campus, New York, NY 10010, USA
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Sedlis SP, Jurkovitz CT, Hartigan PM, Goldfarb DS, Lorin JD, Dada M, Maron DJ, Spertus JA, Mancini GJ, Teo KK, O'Rourke RA, Boden WE, Weintraub WS. Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease. Am J Cardiol 2009; 104:1647-53. [PMID: 19962469 DOI: 10.1016/j.amjcard.2009.07.043] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 07/19/2009] [Accepted: 07/19/2009] [Indexed: 12/22/2022]
Abstract
Chronic kidney disease (CKD) is a risk factor for poor outcomes in patients with coronary artery disease (CAD), but it is unknown whether CKD influences the efficacy of alternative CAD treatment strategies. Thus, we compared outcomes in stable CAD patients with and without CKD randomized to percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or OMT alone in a post hoc analysis of the 2,287 patient COURAGE study. At baseline, 320 patients (14%) had CKD defined as a glomerular filtration rate of <60 mL/min/1.73 m(2), as estimated by the abbreviated 4-variable Modification of Diet in Renal Disease equation. The patients with CKD were older (68 +/- 9 vs 61 +/- 10 years; p <0.001) and more often had diabetes mellitus (42% vs 33%; p = 0.002), hypertension (81% vs 65%; p <0.03), heart failure (13% vs 3.4%; p <001), and three-vessel CAD (37% vs 29%, p = 0.01). After adjustment for these differences, CKD remained an independent predictor of death or nonfatal myocardial infarction (hazard ratio 1.48, 95% confidence interval 1.15 to 1.90). PCI had no effect on these outcomes. Furthermore, at 36 months, a similar percentage of patients with CKD treated with OMT (70%) and PCI plus OMT (76%) were angina free compared to patients without CKD. In conclusion, CKD is an important determinant of clinical outcomes in patients with stable CAD, regardless of the treatment strategy. Although PCI did not reduce the risk of death or myocardial infarction when added to OMT for patients with CKD, it also was not associated with worse outcomes in this high-risk group.
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Rachofsky EL, Fishman M, Grossi E, Lorin JD, Sedlis SP. CLINICAL CHARACTERISTICS OF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION WITH BARE-METAL AND DRUG-ELUTING STENTS. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.544c] [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: 11/01/2022] Open
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Shah B, Kumar N, Garg P, Kang E, Lorin JD, Schwartzbard AZ, Danoff A, Sedlis SP. CLINICAL CHARACTERISTICS OF PATIENTS WITH CORONARY ARTERY DISEASE AND METABOLIC SYNDROME TREATED WITH PERCUTANEOUS INTERVENTION. Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.190s-b] [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: 11/01/2022] Open
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Sedlis SP, Lorin JD. Don't ignore the right radial approach. J Invasive Cardiol 2006; 18:A30. [PMID: 16703689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
Percutaneous intervention with balloon expandable stents has proven to be an effective measure to enhance renal blood flow and control blood pressure in subjects with severe ostial renal artery lesions. A small cohort of these subjects have an ostial bifurcation, which complicates the approach to revascularization. In these cases there is a concern of creating a total side-branch occlusion during balloon expansion. We report two cases of an ostial lesion at a renal artery bifurcation revascularized by employing a sequential dilatation double guidewire technique. Using a single 7F sheath in each case, both renal artery branches were wired, and each branch was predilated and stented in a sequential fashion. Excellent angiographic results were obtained in both cases.
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Affiliation(s)
- Jeffrey D Lorin
- Division of Cardiology, VA New York Harbor Health System Manhattan Campus and New York University School of Medicine, New York, New York 10010, USA.
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Shah B, Liou M, Grossi E, Mass H, Lorin JD, Danoff A, Sedlis SP. Relation of elevated periprocedural blood glucose to long-term survival after percutaneous coronary intervention. Am J Cardiol 2005; 96:543-6. [PMID: 16098309 DOI: 10.1016/j.amjcard.2005.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 01/31/2005] [Revised: 04/08/2005] [Accepted: 04/08/2005] [Indexed: 01/15/2023]
Abstract
Strict glycemic control improves outcomes in critically ill patients. We evaluated the hypothesis that strict glycemic control might be similarly beneficial after percutaneous coronary intervention. This study reports the correlation of periprocedural blood glucose with long-term survival in 1,746 patients who underwent percutaneous coronary intervention from 1990 to 2003 in a Department of Veterans Affairs hospital.
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Affiliation(s)
- Binita Shah
- Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York, USA
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22
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El-Omar MM, Islam N, Broekman MJ, Drosopoulos JHF, Roa DC, Lorin JD, Sedlis SP, Olson KE, Pulte ED, Marcus AJ. The ratio of ADP- to ATP-ectonucleotidase activity is reduced in patients with coronary artery disease. Thromb Res 2005; 116:199-206. [PMID: 15935828 DOI: 10.1016/j.thromres.2004.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Revised: 11/02/2004] [Accepted: 11/28/2004] [Indexed: 11/16/2022]
Abstract
INTRODUCTION CD39 (NTPDase1), an endothelial cell membrane glycoprotein, is the predominant ATP diphosphohydrolase (ATPDase) in vascular endothelium. It hydrolyses both triphosphonucleosides and diphosphonucleosides at comparable rates, thus terminating platelet aggregation and recruitment responses to ADP and other platelet agonists. This occurs even when nitric oxide (NO) formation and prostacyclin production are inhibited. Thus, CD39 represents the main control system for platelet reactivity. Reduced or deficient local ecto-nucleotidase activity may predispose to development of vascular disease. Based on data in animal models and in vitro, CD39 constitutes a new therapeutic modality for vascular disease with a novel and unique mode of action. MATERIALS AND METHODS Lymphocytes were isolated from 46 patients with angiographically proven coronary artery disease (CAD) as well as from matched healthy control subjects. Ectonucleotidase ADPase and ATPase activities (prototypical for the ATPDase activity of endothelial cells) were measured using established radio-TLC procedures. RESULTS AND DISCUSSION In the patients, a decreased ratio of ADPase to ATPase activities (from 1.26 to 1.04) was observed despite increases in both ADPase and ATPase activities. Coronary artery disease was the only independent predictor of a difference in the ADPase/ATPase activity ratio by multivariate linear regression analysis (P=0.0035). This altered ADPase/ATPase activity ratio in patients may represent a reduction in endogenous defense systems against platelet-driven thrombotic events. These data may identify a population of patients with excessive platelet reactivity in their circulation. Increased generation of prothrombotic ADP in these patients implies a potential benefit from therapeutic intervention with soluble forms of CD39.
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Affiliation(s)
- Magdi M El-Omar
- Department of Medicine-Cardiology, New York University Medical School, New York, NY, USA
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Lorin JD, Boglioli JR, Sedlis SP. Successful revascularization of a long chronic total occlusion with blunt microdissection complicated by coronary artery dissection. J Invasive Cardiol 2004; 16:673-6. [PMID: 15550746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We report a case of successful percutaneous revascularization of a chronic total occlusion using the LuMend Frontrunner catheter. The case was complicated by a long coronary artery dissection, with inability to access the true lumen. With favorable healing at 7 weeks, the true lumen was accessible which led to procedural success.
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Affiliation(s)
- Jeffrey D Lorin
- Division of Cardiology, Department of Veterans Affairs, New York Harbor Healthcare System, New York, NY, USA.
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Lorin JD, Liou MC, Sedlis SP. Rapid thrombectomy for treatment of macroembolization during percutaneous coronary intervention in the setting of acute myocardial infarction. Catheter Cardiovasc Interv 2003; 59:219-22. [PMID: 12772245 DOI: 10.1002/ccd.10448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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] [Indexed: 11/12/2022]
Abstract
We report the use of the Export catheter as an urgent modality to aspirate thrombus that embolized down the left anterior descending artery during acute myocardial infarction.
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Affiliation(s)
- Jeffrey D Lorin
- Division of Cardiology, Department of Veterans Affairs, New York Harbor Healthcare System, New York Campus, New York, New York 10010, USA.
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Sedlis SP, Morrison DA, Lorin JD, Esposito R, Sethi G, Sacks J, Henderson W, Grover F, Ramanathan KB, Weiman D, Saucedo J, Antakli T, Paramesh V, Pett S, Vernon S, Birjiniuk V, Welt F, Krucoff M, Wolfe W, Lucke JC, Mediratta S, Booth D, Murphy E, Ward H, Miller L, Kiesz S, Barbiere C, Lewis D. Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry. J Am Coll Cardiol 2002; 40:1555-66. [PMID: 12427406 DOI: 10.1016/s0735-1097(02)02346-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study compared survival after percutaneous coronary intervention (PCI) with survival after coronary artery bypass graft surgery (CABG) among diabetics in the Veterans Affairs AWESOME (Angina With Extremely Serious Operative Mortality Evaluation) study randomized trial and registry of high-risk patients. BACKGROUND Previous studies indicate that CABG may be superior to PCI for diabetics, but no comparisons have been made for diabetics at high risk for surgery. METHODS Over five years (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of five risk factors (prior CABG, myocardial infarction within seven days, left ventricular ejection fraction <0.35, age >70 years, or an intra-aortic balloon being required to stabilize) were identified. A total of 781 were acceptable for CABG and PCI, and 454 consented to be randomized. The 1,650 patients not acceptable for both CABG and PCI constitute the physician-directed registry, and the 327 who were acceptable but refused to be randomized constitute the patient-choice registry. Diabetes prevalence was 32% (144) among randomized patients, 27% (89) in the patient-choice registry, and 32% (525) in the physician-directed registry. The CABG and PCI survival rates were compared using Kaplan-Meier curves and log-rank tests. RESULTS The respective CABG and PCI 36-month survival rates for diabetic patients were 72% and 81% for randomized patients, 85% and 89% for patient-choice registry patients, and 73% and 71% for the physician-directed registry patients. None of the differences was statistically significant. CONCLUSIONS We conclude that PCI is a relatively safe alternative to CABG for diabetic patients with medically refractory unstable angina who are at high risk for CABG.
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Affiliation(s)
- Steven P Sedlis
- Section of Cardiology, 12W, New York VA Medical Center, 423 East 23rd Street, New York, NY 10010, USA.
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26
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Lorin JD, Robin B, Lochow P, Lorenzo A, Sedlis SP. The right radial approach for stenting of lesions in the right coronary artery with anomalous take-off from the left sinus of valsalva. J Invasive Cardiol 2000; 12:478-80. [PMID: 10973375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Angioplasty and stenting of lesions located in anomalous right coronary arteries arising from the left sinus of Valsalva is technically challenging. We suggest that the right radial artery provides a more direct approach that is particularly advantageous in such cases and include illustrative case reports.
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Affiliation(s)
- J D Lorin
- Division of Cardiology, New York VA Medical Center, 423 East 23rd Street, New York, NY 10010, USA
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