118 results on '"Charan Yerasi"'
Search Results
2. Impact of Left Ventricular Outflow Tract Calcification on Outcomes Following Transcatheter Aortic Valve Replacement
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Itsik Ben-Dor, Cheng Zhang, Lowell F. Satler, Toby Rogers, Corey Shea, Brian J. Forrestal, Aaphtaab Dheendsa, Anees Musallam, Ron Waksman, Rebecca Torguson, Charan Yerasi, Brian C. Case, and Kyle Buchanan
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medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Balloon ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Ventricular outflow tract ,In patient ,Paravalvular leak ,Retrospective Studies ,business.industry ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business ,Calcification - Abstract
Background We aimed to determine left ventricular outflow tract (LVOT) calcification impact following transcatheter aortic valve replacement (TAVR) with contemporary transcatheter heart valves. Recent studies reported a higher rate of 2-year mortality with greater than moderate LVOT calcium, but they have not established a reliable and validated method to assess the degree of valve calcification and utilized first-generation valves for their analyses. Materials/methods We conducted a retrospective analysis of patients who underwent TAVR at our institution from 2013 through 2017 with available valves. LVOT calcification quantification was assessed as a continuous variable. Results We included 273 patients: 179 had a non-calcified LVOT (NOLVOTCA) and 96 had a calcified LVOT (LVOTCA). Balloon post-dilatation (BPD) was utilized in 31.3% of LVOTCA vs. 19% of NOLVOTCA (p = 0.029). The Evolut R valve was used in 40.6% vs. 23.4% ( p = 0.002), while the Sapien 3 was used in 59.4% vs. 76.6% (p = 0.004), for the LVOTCA and NOLVOTCA, respectively. Paravalvular leak (PVL) at hospital discharge was higher in LVOTCA (47.5%) versus NOLVOTCA (29.1%; p = 0.004). All-cause mortality (11.5% vs. 10.1%; p = 0.5) and need for permanent pacemaker implantation were similar between the groups. There was a positive trend between LVOT calcification volume and the probability of any PVL (OR 1.012; 95% CI, 0.99–1.02). Conclusions TAVR performed in patients with calcified LVOT is safe, but LVOT calcification adversely impacts TAVR outcomes, with a higher PVL rate despite greater usage of BPD. Calcium quantification did not predict any PVL degree post-TAVR.
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- 2022
3. Transcatheter Aortic Valve Replacement in Low-Risk Bicuspid and Tricuspid Patients: Meta-Analysis
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Christian Shults, Brian C. Case, Charan Yerasi, Giorgio A. Medranda, Ron Waksman, Toby Rogers, Cheng Zhang, and Gheorghe Doros
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Risk ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Investigational device exemption ,030204 cardiovascular system & hematology ,law.invention ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Valve replacement ,Risk Factors ,law ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Stroke ,business.industry ,Bayes Theorem ,Aortic Valve Stenosis ,General Medicine ,Odds ratio ,medicine.disease ,Stenosis ,Treatment Outcome ,Aortic Valve ,Meta-analysis ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Most pivotal transcatheter aortic valve replacement (TAVR) trials have excluded patients with bicuspid aortic stenosis (AS). This study compared TAVR in low-risk patients with bicuspid AS to those with tricuspid AS, incorporating data from prospective trials. Methods We selected prospective US low-risk TAVR trials containing a bicuspid arm for this meta-analysis, examining outcomes at 30 days. Study results were pooled using a hierarchical Bayesian random-effects model. Results Included were 3 Food and Drug Administration (FDA)-approved investigational device exemption (IDE) trials that enrolled a total of 1810 low-risk patients with symptomatic severe AS for TAVR. We compared 380 bicuspid patients with 1430 tricuspid patients. Event rates at 30 days overall were low, with similar mortality (odds ratio [OR], 0.38; 95% credible interval [CrI]: 0.08, 1.78; I2, 0%), non-disabling stroke (OR, 0.45; 95% CrI: 0.15, 1.07; I2 , 9%), and permanent pacemaker implantation (OR, 0.86; 95% CrI: 0.41, 1.47; I 2, 59%). There were statistically significant differences in disabling stroke (OR, 0.16; 95% CrI: 0.01, 0.90; I2 , NA) and coronary obstruction (OR, 0.21; 95% CrI: 0.05, 0.91) that disappeared after sensitivity analysis by adding a single event to the tricuspid arm. Hemodynamics were similar at 30 days. Conclusions Preliminary data from the FDA-approved IDE trials of low-risk patients with bicuspid AS undergoing TAVR demonstrated 30-day outcomes comparable to low-risk tricuspid patients, except for a trend toward higher stroke in bicuspid patients. Randomized trials are warranted to reassure the safety and long-term outcome of TAVR in patients with severe bicuspid AS.
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- 2021
4. High-Risk Percutaneous Coronary Intervention of Native Coronary Arteries Without Mechanical Circulatory Support in Acute Coronary Syndrome Without Cardiogenic Shock
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Nauman Khalid, Brian C. Case, Cheng Zhang, Evan Shlofmitz, Charan Yerasi, Corey Shea, Toby Rogers, Anees Musallam, Itsik Ben-Dor, Ron Waksman, Hayder Hashim, Nelson L. Bernardo, Yuefeng Chen, and Lowell F. Satler
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Male ,Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary artery disease ,Percutaneous Coronary Intervention ,Postoperative Complications ,Risk Factors ,Internal medicine ,medicine ,Humans ,Angina, Unstable ,Assisted Circulation ,Hospital Mortality ,cardiovascular diseases ,Myocardial infarction ,Non-ST Elevated Myocardial Infarction ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Unstable angina ,Cardiogenic shock ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Survival Rate ,Coronary arteries ,medicine.anatomical_structure ,Conventional PCI ,Cardiology ,Feasibility Studies ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Widespread utilization of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI) remains controversial, with a lack of randomized supporting evidence and associated risk of device-related complications. We investigated whether high-risk PCI of native coronary arteries without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. We performed a single-center, retrospective analysis for ACS patients meeting American College of Cardiology high-risk criteria: unprotected left main disease, last remaining conduit, ejection fraction
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- 2021
5. Review of Interventional Late Breaking Trials From AHA Scientific Sessions 2020 Virtual Meeting
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Brian C. Case, Giorgio A. Medranda, Jason P. Wermers, Chava Chezar-Azerrad, Brian J. Forrestal, Charan Yerasi, Natalie Morrison, and Ron Waksman
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BMI, body mass index ,UA, unstable angina ,HT-DES, healing targeted Supreme DES ,Cardiology ,DHA, docosahexaenoic acid ,Article ,MINOCA, myocardial infarction with non-obstructive coronary artery disease ,HDL-C, high-density lipoprotein cholesterol ,TLR, target lesion revascularization ,Humans ,ID, ischemia-driven ,Medicine ,TV, target vessel ,DES, drug-eluting stent ,hsCRP, high-sensitivity C-reactive protein ,NHANES, National Health and Nutrition Examination Survey ,TLF, target lesion failure ,COVID-19, coronavirus disease 2019 ,ACS, acute coronary syndromes ,AHA, American Heart Association ,CA, carboxylic acids ,PCI, percutaneous coronary intervention ,Medical education ,CTCA, computed tomography coronary angiography ,OCT, optical coherence tomography ,business.industry ,General Medicine ,EPA, eicosapentaenoic acid ,CMR, cardiac magnetic resonance imaging ,HR, hazard ratio ,CI, confidence interval ,STEMI, ST-elevation myocardial infarction ,CCS, chronic coronary syndromes ,Cardiovascular Diseases ,Research Design ,DAPT, dual anti-platelet therapy ,MACE, major adverse cardiovascular events ,MI, myocardial infarction ,LDL-C, low-density lipoprotein cholesterol ,DP-DES, polymer based DES ,Cardiology and Cardiovascular Medicine ,business ,Apo-B, apolipoprotein B ,PCSK9, proprotein convertase subtilisin/kexin type 9 - Published
- 2021
6. Pre-Operative Cardiovascular Testing before Liver Transplantation
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Itsik Ben-Dor, Charan Yerasi, Toby Rogers, Brian J. Forrestal, Brian C. Case, Hayder Hashim, Ron Waksman, Rohit Satoskar, Alexander Lalos, Syed Z. Qamer, Michael Yang, Giorgio A. Medranda, Chava Chezar-Azerrad, Nelson L. Bernardo, Lowell F. Satler, and Sant Kumar
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Adult ,Male ,Cardiac Catheterization ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Liver transplantation ,Coronary Angiography ,Revascularization ,End Stage Liver Disease ,Coronary artery disease ,03 medical and health sciences ,Liver disease ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Preoperative Care ,Myocardial Revascularization ,medicine ,Humans ,Myocardial infarction ,Mortality ,Non-ST Elevated Myocardial Infarction ,Aged ,Retrospective Studies ,Cardiac catheterization ,business.industry ,Myocardial Perfusion Imaging ,Middle Aged ,medicine.disease ,Liver Transplantation ,Transplantation ,Cardiovascular Diseases ,Echocardiography ,Exercise Test ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,030211 gastroenterology & hepatology ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business - Abstract
End-stage liver disease (ESLD) is increasingly prevalent and shares many risk factors with coronary artery disease (CAD). No specific guidelines exist for pre-liver transplant evaluation of CAD, and pretransplant cardiovascular testing varies widely. The aim of this study is to characterize pre-transplant cardiac testing practices with post-transplant clinical outcomes. We retrospectively reviewed patients undergoing initial liver transplantation at our transplant center between January 2015 and March 2019. Patients with previous liver transplantation or multi-organ transplantation were excluded. Electronic medical records were reviewed for relevant demographic and clinical data. We included 285 patients with a mean follow-up of 2.4 years. Of 274 patients (96.1%) with pre-transplant transthoracic echocardiogram (TTE), 18 (6.6%) were abnormal. Non-invasive ischemic testing was performed in 193 (68%) patients: 165 (58%) underwent stress TTE, 24 (8%) underwent myocardial perfusion imaging, 3 underwent coronary computed tomography, and 1 underwent exercise electrocardiogram. Sixteen patients (6%) had left heart catheterization of which 10 (63%) were abnormal and 5 proceeded to revascularization before transplant. There were 4 (1.4%) deaths within 30 days of transplant and 23 deaths (8.1%) in total. ST-elevation myocardial infarction was seen in 1 patient within 30 days and 1 patient after 30 days (0.7% total). No cardiovascular deaths were observed. Among patients undergoing liver transplantation, pre-transplantation cardiovascular testing is exceedingly common and post-transplant cardiovascular complications are rare. Additional research is needed to determine the optimal testing and surveillance in this patient population.
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- 2021
7. Review of Structural Late Breaking Trials From the TCT Connect 2020 Virtual Meeting
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Giorgio A, Medranda, Brian C, Case, Jason P, Wermers, Natalie, Morrison, Charan, Yerasi, Brian, Forrestal, Chava, Chezar-Azerrad, and Ron, Waksman
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Transcatheter Aortic Valve Replacement ,Heart Valve Prosthesis ,Humans ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2021
8. Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-Risk Patients With Severe Aortic Stenosis
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Brian C. Case, Toby Rogers, Brian J. Forrestal, Itsik Ben-Dor, Christian Shults, Jaffar M. Khan, Jeffrey E. Cohen, Charan Yerasi, Hector M. Garcia-Garcia, H. Kitahara, Lowell F. Satler, and Ron Waksman
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medicine.medical_specialty ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve replacement ,Risk Factors ,Mitral valve ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Heart valve ,Heart Valve Prosthesis Implantation ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter aortic valve replacement (TAVR) is approved for all patient risk profiles and is an option for all patients irrespective of age. However, patients enrolled in the low- and intermediate-risk trials were in their 70s, and those in the high-risk trials were in their 80s. TAVR has never been systematically tested in young (
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- 2021
9. Real-World Experience of the MANTA Closure Device: Insights From the FDA Manufacturer and User Facility Device Experience (MAUDE) Database
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Chava Chezar-Azerrad, Nauman Khalid, Charan Yerasi, Brian C. Case, Ron Waksman, Sant Kumar, Evan Shlofmitz, Anees Musallam, Lowell F. Satler, Toby Rogers, Brian J. Forrestal, Itsik Ben-Dor, and Jaffar M. Khan
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Surveillance data ,Databases, Factual ,Adverse outcomes ,Vessel occlusion ,Hemorrhage ,030204 cardiovascular system & hematology ,computer.software_genre ,Food and drug administration ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Vascular closure device ,User Facility ,030212 general & internal medicine ,Major complication ,Closure (psychology) ,Database ,United States Food and Drug Administration ,business.industry ,General Medicine ,United States ,Femoral Artery ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,computer ,Vascular Closure Devices - Abstract
Background/purpose The MANTA vascular closure device (VCD) is the first commercially available dedicated closure device for large-bore femoral arterial access-site closure and was approved by the United States Food and Drug Administration (FDA) in February 2019. Real-world data on the most commonly reported complications and modes of failure associated with the MANTA closure device are limited. We analyzed post-marketing surveillance data from FDA's Manufacturer and User Facility Device Experience (MAUDE) database for the MANTA VCD (Teleflex, Wayne, Pennsylvania). Methods/materials Post-marketing surveillance data from the FDA MAUDE database from February 2019 through March 2020 were analyzed, yielding 170 reports. Results Of the 170 reports of major complications involving MANTA devices, 141 reports involved either injury (136) or death (5) related to the device. Of the 141 reports, bleeding was the most common adverse outcome described (45), followed by vessel occlusion (30) and vessel dissection (21). Device malfunction incidents (29 reports) were reported in 4 main categories: failed deployment (16 reports), malposition of the collagen (9), insufficient information (3), and device dislocation (1). Conclusions Our analysis of the MAUDE database demonstrates that in real-world practice, the MANTA VCD was found to be associated with complications, including death, vascular injury , and difficulties with the device itself. Ongoing user education, proctoring, and pre-procedural patient selection are important to minimize risks associated with the MANTA VCD.
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- 2021
10. Review of Structural Late-Breaking Trials From the TVT Connect 2020 and PCR e-Course 2020 Virtual Meetings
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Brian J. Forrestal, Chava Chezar-Azerrad, Brian C. Case, Giorgio A. Medranda, Ron Waksman, and Charan Yerasi
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Internet ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,General Medicine ,Congresses as Topic ,030204 cardiovascular system & hematology ,medicine.disease ,Polymerase Chain Reaction ,Article ,03 medical and health sciences ,Treatment Outcome ,0302 clinical medicine ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Abstract
Highlights • COVID-19 pandemic replaced face-to-face meetings with virtual ones. • We give highlights of late-breaking trials presented at the TVT Connect 2020. • We also report on selected structural trials presented at PCR e-Course 2020.
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- 2021
11. Comparison of Characteristics and Outcomes of Patients With Acute Myocardial Infarction With Versus Without Coronarvirus-19
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Itsik Ben-Dor, Cheng Zhang, Lowell F. Satler, Corey Shea, Hank Rappaport, Hayder Hashim, Ron Waksman, Giorgio A. Medranda, Toby Rogers, Brian J. Forrestal, Brian C. Case, and Charan Yerasi
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Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.drug_class ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,non-ST-elevation myocardial infarction ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Natriuretic peptide ,Humans ,Medicine ,myocardial injury ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Retrospective Studies ,Aged, 80 and over ,biology ,business.industry ,Clinical course ,COVID-19 ,Middle Aged ,medicine.disease ,Troponin ,ST-elevation myocardial infarction ,Concomitant ,Cohort ,Cardiology ,biology.protein ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted the US healthcare system. Cardiac involvement in COVID-19 is common and manifested by troponin and natriuretic peptide elevation and tends to have a worse prognosis. We analyzed patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) with either an ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) early in the pandemic (March 1, 2020 – June 30, 2020) using the International Classification of Diseases, Tenth Revision. Patients’ clinical course and outcomes, including in-hospital mortality, were compared on the basis of the results of COVID-19 status (positive or negative). The cohort included 1533 patients admitted with an acute myocardial infarction (AMI), of whom 86 had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, during the study period. COVID-19-positive patients were older and non-White and had more co-morbidities. Furthermore, inflammatory markers and N-terminal-proB-type-natriuretic peptide were higher in COVID-19-positive AMI patients. Only 20.0% (17) of COVID-19-positive patients underwent coronary angiography. In-hospital mortality was significantly higher in AMI patients with concomitant COVID-19-positive status (27.9%) than in patients without COVID-19 during the same period (3.7%; p
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- 2021
12. Intravascular ultrasound guidance in the evaluation and treatment of left main coronary artery disease
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Gary S. Mintz, Charan Yerasi, Brian C. Case, Evan Shlofmitz, Brian J. Forrestal, Hector M. Garcia-Garcia, and Ron Waksman
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medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Intravascular ultrasound ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Stent ,Percutaneous coronary intervention ,equipment and supplies ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Angiography ,Conventional PCI ,cardiovascular system ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) disease has become an acceptable revascularization strategy. Evaluating the extent and characteristics of obstructive disease of the LMCA by angiography is challenging and limited in its accuracy. In contrast, intravascular ultrasound (IVUS) provides accurate imaging of the coronary lumen as well as quantitative measurements and quantitative assessment of the vessel wall components. IVUS for LMCA PCI should be performed before, during, and after intervention; IVUS enhances every step in the procedure and is associated with a mortality advantage in comparison with angiographic guidance alone. In this review, we provide an update on LMCA PCI and the role of IVUS for lesion assessment and stent optimization. In addition, the latest clinical evidence of the benefits of IVUS-guided LMCA PCI as compared to angiography is reviewed.
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- 2021
13. Admissions Rate and Timing of Revascularization in the United States in Patients With Non-ST-Elevation Myocardial Infarction
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Sarahfaye Dolman, Brian C. Case, Joshua Hahm, Charan Yerasi, Ron Waksman, William S. Weintraub, Yanying Wang, and Brian J. Forrestal
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Comorbidity ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,Time-to-Treatment ,law.invention ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Randomized controlled trial ,law ,Early Medical Intervention ,Internal medicine ,Diabetes Mellitus ,Myocardial Revascularization ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Coronary Artery Bypass ,Mortality ,Non-ST Elevated Myocardial Infarction ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Percutaneous coronary intervention ,Anemia ,Arrhythmias, Cardiac ,Blood Coagulation Disorders ,Middle Aged ,medicine.disease ,United States ,Hospitalization ,Clinical trial ,medicine.anatomical_structure ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Clinical trials have shown improved outcomes with an early invasive approach for non-ST-elevation myocardial infarction (NSTEMI). However, real-world data on clinical characteristics and outcomes based on time to revascularization are lacking. We aimed to analyze NSTEMI rates, revascularization timing, and mortality using the 2016 Nationwide Readmissions Database. We identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Our analysis included 748,463 weighted NSTEMI hospitalizations in 2016. Of these hospitalizations, 50.3% (376,695) involved diagnostic angiography, with 34.1% (255,199) revascularized. Of revascularized patients, 77.6% (197,945) underwent PCI and 22.4% (57,254) underwent CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission (32.9%; 65,155). This differs from CABG, which was most commonly performed on day 3 after admission (13.7%; 7,823). The in-hospital mortality rate increased after day 1 for PCI patients and after day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed. Our study shows that patients undergoing early revascularization differ from those undergoing later revascularization. Mortality is generally high with delayed revascularization, as these are sicker patients. Randomized clinical trials are needed to evaluate whether very early revascularization (
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- 2020
14. Procedural Characteristics and Outcomes of Patients Undergoing Percutaneous Coronary Intervention During Normal Work Hours Versus Non-work Hours
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Itsik Ben-Dor, Charan Yerasi, Hayder Hashim, Brian C. Case, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Toby Rogers, Brian J. Forrestal, Ron Waksman, Rebecca Torguson, Cheng Zhang, Anees Musallam, William S. Weintraub, and Jason P. Wermers
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Cohort Studies ,Angina ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,After-Hours Care ,Internal medicine ,medicine ,Humans ,Angina, Stable ,Angina, Unstable ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Retrospective Studies ,business.industry ,Unstable angina ,Percutaneous coronary intervention ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Treatment Outcome ,Conventional PCI ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Percutaneous coronary intervention (PCI) performed during non-work hours is believed to have inferior outcomes because of operator fatigue, differences in baseline patient characteristics, and fewer on-call catheterization laboratory staff. We aimed to analyze a cohort of patients who underwent PCI (all comers) at our tertiary-care center between January 1, 2006, and December 31, 2018, and compare procedural and in-hospital outcomes between 2 groups defined by whether PCI was performed during normal work hours (7:00 A.M. to 7:00 PM) versus non-work hours (7:01 P.M. to 6:59 A.M. weekdays; all hours weekends and holidays). Finally, we examined temporal changes throughout the 24-hour weekday. Primary outcomes were unadjusted in-hospital adverse outcomes (composite death, recurrent myocardial infarction, emergent coronary artery bypass grafting, and target lesion revascularization). We identified 21,848 patients who underwent PCI at our institution. The proportions of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) were higher during non-work hours. Overall, unadjusted in-hospital adverse outcomes were higher during non-work hours than during normal work hours (8.80% vs 2.00%; p
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- 2020
15. Review of CRT 2020 Late-breaking Trials
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Brian J. Forrestal, Charan Yerasi, Brian C. Case, and Ron Waksman
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Clinical Trials as Topic ,medicine.medical_specialty ,Mitral regurgitation ,Heart Diseases ,business.industry ,medicine.medical_treatment ,Cardiology ,General Medicine ,Congresses as Topic ,Treatment Outcome ,Drug-eluting stent ,Internal medicine ,Humans ,Medicine ,Diffusion of Innovation ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
16. Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation
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Abhishek Deshmukh, Mayur Patel, Sopan Lahewala, Shilpkumar Arora, Charan Yerasi, Parvir Aujla, Abhishek Bhagat, Gagandeep Singh, Aneesh Tolat, Purnima Sharma, Byomesh Tripathi, Varun Kumar, and Vamsidhar Naraparaju
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medicine.medical_specialty ,business.industry ,Anemia ,medicine.medical_treatment ,Incidence (epidemiology) ,Catheter ablation ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Ventricular tachycardia ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,Internal medicine ,Cardiology ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Dyslipidemia ,Kidney disease - Abstract
Background Utilization of catheter ablation of ventricular tachycardia (VT) has steadily increased in recent years. Exploring short-term outcomes is vital in health care planning and resource allocation. Methods The Nationwide Readmissions Database from 2010 to 2014 was queried using the ICD-9 codes for VT (427.1) and catheter ablation (37.34) to identify study population. Incidence, causes of 30-day readmission, in-hospital complications as well as predictors of 30-day readmissions, complications, and cost of care were analyzed. Results Among 11 725 patients who survived to discharge after index admission for VT ablation, 1911 (16.3%) were readmitted within 30 days. Paroxysmal VT was the most common cause of 30-day readmission (39.51%). Dyslipidemia, chronic kidney disease (CKD), previous CABG, congestive heart failure (CHF), chronic pulmonary disease, and anemia predicted increased risk of 30-day readmissions. The overall in-hospital complication rate was 8.2% with vascular and cardiac complications being the most common. Co-existing CKD and CHF and the need for mechanical circulatory support (MCS) predicted higher complication rates. Similarly increasing age, CKD, CHF, anemia, in-hospital use of MCS or left heart catheterization, teaching hospital, and disposition to nursing facilities predicted higher cost. Conclusion Approximately one in six patients was readmitted after VT ablation, with paroxysmal VT being the most common cause of the readmission. A complication rate of 8.2% was noted. We also identified a predictive model for increased risk of readmission, complication, and factors influencing the cost of care that can be utilized to improve the outcomes related to VT ablation.
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- 2020
17. The Orsiro Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Stent: A Review of Current Evidence
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Hector M. Garcia-Garcia, Brian C. Case, Ron Waksman, Brian J. Forrestal, and Charan Yerasi
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medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Bioresorbable polymers ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Coronary artery disease ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Absorbable Implants ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Sirolimus ,business.industry ,Stent ,Cardiovascular Agents ,Drug-Eluting Stents ,General Medicine ,equipment and supplies ,medicine.disease ,Surgery ,Treatment Outcome ,Small vessel ,Cardiology and Cardiovascular Medicine ,business ,Stent design ,medicine.drug - Abstract
Advances in stent design and the development of bioresorbable polymers have allowed the development of novel stent technologies such as the Orsiro bioresorbable-polymer sirolimus eluting stent (BP-SES). Over several noninferiority trials, the BP-SES has demonstrated itself to be a safe and effective therapy for obstructive coronary artery disease. This article reviews the current evidence of the efficacy of the BP-SES and examines its performance in high-risk populations, such as patients presenting with ST-segment myocardial infarction, chronic total occlusions, diabetes, and small vessel disease.
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- 2020
18. Drug-Coated Balloon for De Novo Coronary Artery Disease
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Brian J. Forrestal, Charan Yerasi, Rebecca Torguson, Ron Waksman, Brian C. Case, Hector M. Garcia-Garcia, and William S. Weintraub
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medicine.medical_specialty ,Drug coated balloon ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Stent ,State of the art review ,030204 cardiovascular system & hematology ,equipment and supplies ,medicine.disease ,Revascularization ,Coronary artery disease ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Restenosis ,Internal medicine ,Cardiology ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Paclitaxel eluting balloon ,Cardiology and Cardiovascular Medicine ,business - Abstract
Percutaneous coronary intervention with a drug-eluting stent is the most common mode of revascularization for coronary artery disease. However, restenosis rates remain high. Non-stent-base...
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- 2020
19. Usefulness of Temporary Pacing in Patients With New Left Bundle Branch Block During Transcatheter Aortic Valve Implantation
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Chava Chezar-Azerrad, Vijaywant Brar, Amna Nawaz, Brian J. Forrestal, Charan Yerasi, Brian C. Case, Giorgio A. Medranda, Anees Musallam, Itsik Ben-Dor, Jason P. Wermers, Susan O'Donoghue, Lowell F. Satler, Toby Rogers, and Ron Waksman
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Male ,Pacemaker, Artificial ,Bundle-Branch Block ,Cardiac Pacing, Artificial ,COVID-19 ,Arrhythmias, Cardiac ,Aortic Valve Stenosis ,Transcatheter Aortic Valve Replacement ,Postoperative Complications ,Treatment Outcome ,Aortic Valve ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,Atrioventricular Block ,Pandemics - Abstract
New-onset left bundle branch block (NLBBB) is the most common complication after transcatheter aortic valve implantation (TAVI). Expert consensus recommends temporary transvenous pacemaker (TTVP) support for 24 hours in these patients. To date, no study has examined TTVP use during the index hospitalization in detail. Therefore, we aimed to assess TTVP use in patients with TAVI who developed NLBBB. In this prospective observational study, we performed a detailed analysis of 24-hour telemetry in patients who developed NLBBB during TAVI. Baseline characteristics and procedural and postprocedural data were recorded. The primary outcome was pacing by the TTVP. We evaluated inappropriate TTVP use, electrophysiology study findings, permanent pacemaker (PPM) implantation, and NLBBB resolution. A total of 83 patients (74.4 ± 8.7 years, 41% female) developed NLBBB during TAVI. During index hospitalization, 1 patient (1%) required TTVP because of complete heart block and received a PPM. Five of the 83 (6%) patients were inappropriately paced, and 1 patient (1%) had ventricular fibrillation, likely secondary to TTVP. A total of 34 patients (41%) underwent electrophysiology study during hospitalization, with 4 of 83 (5%) subsequently receiving a PPM. One (1%) patient died during hospitalization, and 9 patients were lost to follow-up because of the COVID-19 pandemic. Of the remaining 73 patients with a 30-day follow-up, NLBBB had resolved in 36 (49%) at 30 days, and 2 (3%) were readmitted with complete heart block and received PPM. In conclusion, in patients with TAVI who develop NLBBB, temporary pacing is rarely necessary, may carry additional risks to the patient, and prolong hospitalization time.
- Published
- 2022
20. Safety and Feasibility of Performing Pericardiocentesis on Patients with Significant Pulmonary Hypertension
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Muhammad Tariq, Ron Waksman, Toby Rogers, Hayder Hashim, Brian J. Forrestal, Itsik Ben-Dor, Michael Yang, Charan Yerasi, Brian C. Case, Diego Medvedofsky, Calvin M. Kagan, and Lowell F. Satler
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Pericardial effusion ,Pericardial Effusion ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pulmonary Arterial Hypertension ,business.industry ,Hemodynamics ,Pericardiocentesis ,General Medicine ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Surgery ,Treatment Outcome ,Cohort ,Ventricular Function, Right ,Etiology ,Feasibility Studies ,Invasive hemodynamic monitoring ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Background/purpose Pericardial effusion (PE) is a complication of pulmonary hypertension (PHT) and, specifically, pulmonary arterial hypertension (PAH), that confers a worse prognosis. The safety of performing pericardiocentesis in patients with PHT has not been established. We aimed to assess the safety and feasibility of performing pericardiocentesis in patients with significant PHT. Methods/materials We performed a retrospective analysis from August 2013 to December 2018 at our tertiary-care center of patients who underwent a pericardiocentesis procedure. Patients, procedure, echocardiographic findings, any major intraprocedural complications, and post-procedural related complications up to 30 days were recorded. Specifically, we studied patients with significant PHT. Results The cohort included 170 patients, with an average age of 62.6 years and an even distribution of gender and co-morbidities. The etiology for the PE varied. Major complications were rare (1.7%) and only 10 patients (5.9%) required re-intervention for reaccumulation of fluid. There were 27 patients (15.9%) with significant PHT, 5 with World Health Organization (WHO) Group I PAH (2.94%). In the entire cohort, there were only 3 major complications (1.7%), none among PHT patients. Conclusions Pericardiocentesis is a safe procedure, including in patients with significant PHT, including those with WHO Group I PAH. We advocate the use of invasive hemodynamic monitoring in patients with significant PHT. Summary Pericardiocentesis tends to be a safe procedure. However, the safety of performing pericardiocentesis in patients with significant pulmonary hypertension has not been well established. We aimed to assess the safety and feasibility of performing pericardiocentesis, and specifically in patients with significant PHT out our tertiary center by performing a retrospective analysis.
- Published
- 2019
21. Predictors of 90-Day Readmission and in-Hospital Mortality in Takotsubo Cardiomyopathy: An Analysis of 28,079 Index Admissions
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Itsik Ben-Dor, Sandeep Banga, Anil Kumar Jonnalagadda, Ron Waksman, Byomesh Tripathi, Camila McNown, Varun Miryala, Saifuldeen Al-Qaisi, Charan Yerasi, and Sina Nafisi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Multivariate analysis ,Adolescent ,Databases, Factual ,Anemia ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Patient Readmission ,Risk Assessment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Takotsubo Cardiomyopathy ,Cause of Death ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Vascular disease ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,United States ,Heart failure ,Cohort ,Etiology ,Female ,Diagnosis code ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Takotsubo cardiomyopathy (TC) is diagnosed in 1% to 2% of patients presenting with suspected acute coronary syndromes. Readmission patterns after TC have been less studied. Thus, we sought to perform a study to evaluate the etiologies, trends, and predictors of 90-day readmission in TC. Methods The Nationwide Readmissions Database (NRD), 2014, was used to select the study cohort. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code 429.83 was used to identify TC. Admissions within 90 days of index admission were considered early readmissions. Readmission etiologies were identified by an ICD-9-CM code. Hierarchical multivariate models were used to evaluate predictors of early readmission. Results A total of 28,079 patients were identified during the study period, of whom 24.3% (n = 6841) were readmitted within 90 days of discharge. In-hospital mortality during index admissions was 5.69%. The most common etiologies for readmission were cardiac (18.56%), respiratory (17.20%), and infections (13.12%). Among cardiac complications, acute heart failure was the most common etiology (7.48%). The highest number of readmissions happened on the first day after discharge (n = 125). On multivariate analysis, the age of 50–64 years, diabetes, heart failure, chronic pulmonary disease, peripheral vascular disease, anemia, and malignancy were shown to be significant predictors of readmission. Patients of female gender are less likely to be readmitted and have lower in-hospital mortality. Conclusions Patients with TC are highly likely to be readmitted within the first month after discharge, most likely with secondary to cardiac or respiratory complications. These findings warrant close post-discharge transition to reduce morbidity and improve healthcare outcomes. Summary This analysis from the Nationwide Readmission Database outlines a detailed analysis on etiologies, trends, and predictors of 90-day readmission for patients presenting with takotsubo cardiomyopathy.
- Published
- 2019
22. Impact of Baseline Imaging of Non-Culprit Coronary Lesions on Adverse Events: Insight From LRP Study
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Brian C. Case, Corey Shea, Rebecca Torguson, Cheng Zhang, Charan Yerasi, Giorgio A. Medranda, Kayode O. Kuku, Hector M. Garcia-Garcia, Gary S. Mintz, and Ron Waksman
- Subjects
Myocardial Infarction ,Humans ,General Medicine ,Coronary Artery Disease ,Cardiology and Cardiovascular Medicine ,Coronary Angiography ,Coronary Vessels ,Plaque, Atherosclerotic - Abstract
Intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) can identify vulnerable coronary atherosclerotic plaques. We aimed to compare the presence or absence of baseline intravascular imaging of non-culprit lesions and their subsequent adverse events.We identified patients from the Lipid Rich Plaque (LRP) study who had a non-culprit-lesion adverse event and divided them into 2 cohorts: those with lesions detected with NIRS-IVUS imaging at baseline and those with lesions not imaged at baseline.Overall, 73 patients had an adverse event (99 coronary segments) during the 24-month follow-up period. Among them, 41 patients (56.2%) had a non-culprit-lesion adverse event related to a coronary segment imaged at baseline, and 32 patients (43.8%) had a non-culprit-lesion adverse event adjudicated to a segment that was not scanned at baseline. Angiographic core laboratory analysis suggested that unscanned lesions were more often in the right coronary artery (~50%); branches of the left coronary artery, i.e., diagonal or left obtuse marginal arteries (~20%); smaller vessels; or more tortuous vessels; and less often in the left anterior descending or distal locations. There was a weak trend for acute severe events (adjudicated myocardial infarction and acute coronary syndrome) in patients with lesions not scanned at baseline (50.0% versus 36.6%, p = 0.250).In patients with follow-up non-culprit-lesion adverse events, nearly half were not imaged with NIRS-IVUS at baseline. Because events related to non-imaged lesions were at least as severe as events related to imaged lesions, future clinical trials and clinical protocols should be designed to minimize this issue.The Lipid-Rich Plaque Study (LRP), https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.
- Published
- 2021
23. Impact of Baseline Imaging of Non-Culprit Coronary Lesions and Adverse Events: Insight From LRP Study
- Author
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Brian C. Case, Corey Shea, Cheng Zhang, Charan Yerasi, Giorgio A. Medranda, Kayode O. Kuku, Hector M. Garcia-Garcia, Gary S. Mintz, and Ron Waksman
- Subjects
General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
24. The evolution of management and outcomes of patients with myocardial injury during the COVID-19 pandemic
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Brian C. Case, Itsik Ben-Dor, J Abramowitz, L.F. Satler, Ron Waksman, Toby Rogers, Hayder Hashim, H Rappaport, Brian J. Forrestal, C Zhang, Charan Yerasi, G Medranda, C Chezar-Azerrad, William S. Weintraub, and C Shea
- Subjects
Mechanical ventilation ,medicine.medical_specialty ,biology ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Hospital mortality ,Troponin ,Pandemic ,Emergency medicine ,Troponin I ,medicine ,biology.protein ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation, and associated with worse prognosis as compared with patients without myocardial injury. Purpose We sought to evaluate if the outcomes of these patients has improved as experience accumulated during the pandemic. Methods We analyzed COVID-19-positive patients with the evidence of myocardial injury (defined as troponin elevation) who presented to our large US healthcare system in the northeast region during the “Early Phase” of the pandemic (March 1–June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the “Current Phase” of the pandemic (October 1, 2020–January 31, 2021). Results The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the “Early Phase” and 621 during the “Current Phase”. The cohort's mean age was 70.2±14.9 years; 54.3% were men (Figure 1). Maximum troponin-I in the “Early Phase” was 13.46±34.72 versus 11.21±20.57 in the “Current Phase” (p=0.553) In-hospital mortality was significantly higher (50.3%) in the “Early Phase” group compared to the “Current Phase” group (24.6%; p Conclusions Treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies and provider experience. Funding Acknowledgement Type of funding sources: None.
- Published
- 2021
25. The Need for Additional Phenotyping When Defining Cardiogenic Shock
- Author
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Charan Yerasi, Brian C. Case, Mohit Pahuja, Itsik Ben-Dor, and Ron Waksman
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Heart Failure ,Treatment Outcome ,Shock, Cardiogenic ,Ventricular Function, Right ,Humans ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine - Published
- 2021
26. Comparison of Outcomes in Patients with COVID-19 and Thrombosis vs. Those Without Thrombosis
- Author
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Hank Rappaport, Itsik Ben-Dor, Lowell F. Satler, Chava Chezar-Azerrad, Toby Rogers, Brian J. Forrestal, Charan Yerasi, William S. Weintraub, Giorgio A. Medranda, Brian C. Case, Cheng Zhang, Hayder Hashim, Ron Waksman, Corey Shea, and Jonathan Abramowitz
- Subjects
Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Article ,In-hospital outcomes ,Internal medicine ,Antithrombotic ,medicine ,Humans ,Hospital Mortality ,Myocardial infarction ,Aged ,Aged, 80 and over ,Venous Thrombosis ,SARS-CoV-2 ,business.industry ,Coronary Thrombosis ,Mortality rate ,COVID-19 ,Thrombosis ,Middle Aged ,medicine.disease ,Stroke ,Concomitant ,Cohort ,Cardiology ,Myocardial infarction complications ,Female ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
The occurrence of venous thromboembolisms in patients with COVID-19 has been established. We sought to evaluate the clinical impact of thrombosis in patients with COVID-19 over the span of the pandemic to date. We analyzed patients with COVID-19 with a diagnosis of thrombosis who presented to the MedStar Health system (11 hospitals in Washington, District of Columbia, and Maryland) during the pandemic (March 1, 2020, to March 31, 2021). We compared the clinical course and outcomes based on the presence or absence of thrombosis and then, specifically, the presence of cardiac thrombosis. The cohort included 11,537 patients who were admitted for COVID-19. Of these patients, 1,248 had noncardiac thrombotic events and 1,009 had cardiac thrombosis (myocardial infarction) during their hospital admission. Of the noncardiac thrombotic events, 562 (45.0%) were pulmonary embolisms, 480 (38.5%) were deep venous thromboembolisms, and 347 (27.8%) were strokes. In the thrombosis arm, the mean age of the cohort was 64.5 ± 15.3 years, 53.3% were men, and the majority were African-American (64.9%). Patients with thrombosis tended to be older with more co-morbidities. The in-hospital mortality rate was significantly higher (16.0%) in patients with COVID-19 with concomitant non-cardiac thrombosis than in those without thrombosis (7.9%, p
- Published
- 2021
27. CRT-400.08 Impact of Baseline Imaging of Non-Culprit Coronary Lesions and Adverse Events: Insight From LRP Study
- Author
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Brian C. Case, Corey Shea, Cheng Zhang, Charan Yerasi, Giorgio A. Medranda, Kayode O. Kuku, Hector M. Garcia-Garcia, Gary S. Mintz, and Ron Waksman
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
28. Contemporary post-marketing adverse events and modes of failure related to VASCADE Vascular Closure System: The utility of the MAUDE database
- Author
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Brian C. Case, Itsik Ben-Dor, Sant Kumar, Hayder Hashim, Giorgio A. Medranda, Toby Rogers, Brian J. Forrestal, Nelson L. Bernardo, Lowell F. Satler, Ron Waksman, and Charan Yerasi
- Subjects
Marketing ,Database ,Databases, Factual ,business.industry ,United States Food and Drug Administration ,General Medicine ,computer.software_genre ,medicine.disease ,United States ,Food and drug administration ,Femoral Artery ,Pseudoaneurysm ,Treatment Outcome ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,User Facility ,Major complication ,Closure (psychology) ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Adverse effect ,computer ,Device failure - Abstract
Objectives To analyze post-marketing surveillance data from the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for the VASCADE Vascular Closure System (Cardiva Medical Inc., Santa Clara, CA). Background The VASCADE Vascular Closure System is a closure device for femoral arterial and venous access-site closure that was approved by the FDA in 2013. However, post-marketing data and experience on the most commonly reported complications and modes of failure associated with the VASCADE Vascular Closure System are limited. Methods Post-marketing surveillance data from the FDA MAUDE database from October 2013 through March 2020 were analyzed, yielding 201 reports. Results Of the 201 reports of major complications involving VASCADE devices, 156 reports involved either injury (145) or death (11) related to the device. Of the 145 injury reports, bleeding was the most common adverse outcome described (85), followed by pseudoaneurysm (29) and pulselessness of an extremity (21). The device malfunction incidents (41 reports) were reported in three main categories, with deployment failure being the most commonly reported complication. Conclusions Our analysis of the MAUDE database demonstrates that in contemporary post-marketing practice, physicians should be well-trained and educated to use the VASCADE closure device because improper utilization is a common cause of device failure, and complications with the VASCADE device can have profound clinical implications.
- Published
- 2021
29. High bleeding risk patients: one size does not fit all
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Charan Yerasi and Ron Waksman
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medicine.medical_specialty ,Text mining ,Editorial ,business.industry ,medicine ,MEDLINE ,Humans ,Hemorrhage ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
30. TCT-65 Characteristics of COVID-19 Patients With Thrombosis and Impact on Clinical Outcomes
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Itsik Ben-Dor, Ron Waksman, Toby Rogers, Giorgio A. Medranda, Jonathan Abramowitz, Corey Shea, Hank Rappaport, Brian Case, William S. Weintraub, Charan Yerasi, Lowell F. Satler, Chava Chezar-Azerrad, Cheng Zhang, and Hayder Hashim
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Intensive care medicine ,Thrombosis ,Article - Published
- 2021
31. Meta-Analysis of Usefulness of Antiplatelet Therapy in Ischemic Stroke or Transient Ischemic Attack
- Author
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Giorgio A. Medranda, William S. Weintraub, Ron Waksman, Brian C. Case, Gheorghe Doros, Cheng Zhang, and Charan Yerasi
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medicine.medical_specialty ,Ticagrelor ,Hemorrhage ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Early Medical Intervention ,medicine ,Secondary Prevention ,Humans ,cardiovascular diseases ,Symptom onset ,Mortality ,Ischemic Stroke ,Proportional Hazards Models ,Aspirin ,business.industry ,Dual Anti-Platelet Therapy ,Hazard ratio ,Clopidogrel ,Ischemic Attack, Transient ,Meta-analysis ,Ischemic stroke ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
The efficacy of early administration of dual antiplatelet therapy (DAPT) for secondary prevention after acute ischemic stroke or transient ischemic attack (TIA) is uncertain. This systematic review and meta-analysis compares the safety and efficacy of early administration (
- Published
- 2021
32. A Patient-Level, Pooled Analysis of Mortality Rates With the Passeo-18 Lux Paclitaxel Drug-Coated Balloon in Peripheral Arterial Disease
- Author
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Paige Craig, Brian C. Case, Charan Yerasi, Nelson L. Bernardo, Cheng Zhang, Rebecca Torguson, Ron Waksman, and Brian J. Forrestal
- Subjects
Target lesion ,Chronic Limb-Threatening Ischemia ,medicine.medical_specialty ,Percutaneous ,Time Factors ,Paclitaxel ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Revascularization ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Coated Materials, Biocompatible ,Angioplasty ,Medicine ,Humans ,Cumulative incidence ,Popliteal Artery ,030212 general & internal medicine ,Prospective Studies ,business.industry ,Mortality rate ,General Medicine ,Critical limb ischemia ,Surgery ,Femoral Artery ,Treatment Outcome ,Amputation ,Pharmaceutical Preparations ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Angioplasty, Balloon - Abstract
Background Recent meta-analyses have raised concerns about mortality with paclitaxel drug-coated balloons (DCB). This pooled, patient-level analysis of the BIOLUX P-I, P-II, and P-III studies was performed to evaluate the safety and efficacy of Passeo-18 Lux DCB. Materials and Methods Individual patient-level demographic, clinical, diagnostic, and procedural data from the BIOLUX P-I, BIOLUX P-II, and BIOLUX P-III studies were pooled in a common database. Clinical safety (all-cause mortality and cardiovascular mortality) and efficacy (any amputation, target lesion/vessel revascularization) were extracted. Cox proportional modeling was used to assess the effect of critical limb ischemia at the time of enrollment and the occurrence of new amputation as a time-dependent variable on mortality. Results A total of 1009 patients were included in the analysis. Sixty-six patients were treated with percutaneous transluminal angioplasty (PTA) and 943 underwent DCB angioplasty . The cumulative incidence of all-cause mortality did not differ between the groups (PTA 6.7%, DCB 6.7%, p = 0.65). The composite efficacy endpoint of freedom from any amputation and target lesion/vessel revascularization was superior in the DCB arm compared to PTA [PTA 28.8%, DCB 16.7%, p = 0.02]. Both in unadjusted and adjusted Cox proportional models (adjusted for critical limb ischemia and amputation), the use of DCB was not associated with any mortality at 1 year. Conclusions Our patient-level analysis shows that overall the use of the Passeo-18 Lux paclitaxel DCB in infrainguinal arteries was not associated with increased mortality at 1 year and reinforces the efficacy of DCB angioplasty in preventing amputation or the need for reintervention.
- Published
- 2021
33. Implications of Left Ventricular Function on Short-Term Outcomes in COVID-19 Patients with Myocardial Injury☆
- Author
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Hank Rappaport, William S. Weintraub, Hooman Fazlalizadeh, Giorgio A. Medranda, Ron Waksman, Cheng Zhang, Brian C. Case, Charan Yerasi, and Corey Shea
- Subjects
Adult ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,CAD, coronary artery disease ,TTE, transthoracic echocardiogram ,Cardiomyopathy ,030204 cardiovascular system & hematology ,AKI, acute kidney injury ,SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 ,Ventricular Function, Left ,Article ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,CMR, cardiac magnetic resonance ,Internal medicine ,Medicine ,Humans ,EF, ejection fraction ,In patient ,myocardial injury ,030212 general & internal medicine ,COVID-19, coronavirus disease 2019 ,PCI, percutaneous coronary intervention ,Ejection fraction ,biology ,Ventricular function ,business.industry ,SARS-CoV-2 ,troponin ,readmission ,NSTEMI, non-ST-segment elevation myocardial infarction ,COVID-19 ,Stroke Volume ,left ventricular ejection fraction ,General Medicine ,medicine.disease ,Troponin ,ICU, intensive care unit ,biology.protein ,Cardiology ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,Complication ,business ,LOS, length of stay - Abstract
BACKGROUND: Myocardial injury is a complication of coronavirus disease 2019 (COVID-19). We describe a large multi-center experience of COVID-19 patients with myocardial injury, examining the prognostic role left ventricular function plays on short-term outcomes. METHODS/MATERIALS: We included adult COVID-19 patients admitted to our health system with evidence of myocardial injury and who underwent a transthoracic echocardiogram (TTE) during index admission. Patients were dichotomized into those with reduced ejection fraction (EF
- Published
- 2021
34. Balloon-Expandable Valve Geometry After Transcatheter Aortic Valve Replacement in Low-Risk Patients With Bicuspid Versus Tricuspid Aortic Stenosis
- Author
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Mariano E. Brizzio, Brian C. Case, Robert Levitt, Lowell F. Satler, Maurice Buchbinder, Brian J. Forrestal, Federico M. Asch, Paul Mahoney, Corey Shea, Itsik Ben-Dor, George M. Comas, Ron Waksman, Puja B. Parikh, Toby Rogers, Thomas V. Bilfinger, Christian Shults, Thomas P. Cocke, Giorgio A. Medranda, Rebecca Torguson, Nicholas Hanna, Paige Craig, Joseph Newton, Cheng Zhang, Chiwon Hahn, Hector M. Garcia-Garcia, Gaby Weissman, Charan Yerasi, W. Guy Weigold, and Chava Chezar-Azerrad
- Subjects
Aortic valve ,Transcatheter aortic ,medicine.medical_treatment ,Hemodynamics ,Geometry ,030204 cardiovascular system & hematology ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid aortic valve ,Valve replacement ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Heart valve ,Prospective Studies ,Stroke ,business.industry ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Prospective bicuspid low-risk transcatheter aortic valve replacement (TAVR) registries' data demonstrated encouraging short-term results. Detailed data on transcatheter heart valve (THV) geometry after deployment using contemporary devices are lacking. This study sought to examine valve geometry after TAVR in patients with bicuspid aortic stenosis (AS). Methods The study population was patients from the LRT (Low Risk TAVR) trial who underwent TAVR using the SAPIEN 3 THV for bicuspid and tricuspid AS. THV geometry measured on 30-day computed tomography (CT) included valve height, angle, depth, and eccentricity. Additionally, THV hemodynamics and outcomes post-TAVR were compared among patients with bicuspid and tricuspid AS. Results A total of 107 patients from the LRT trial using the SAPIEN 3 THV were included in our analysis. On 30-day CT, the valve height ratio (1.07 vs. 1.07; p = 0.348), depths (right [5.6 mm vs. 6.2 mm; p = 0.223], left [5.3 mm vs. 4.4 mm; p = 0.082] and non [4.8 mm vs. 4.5 mm; p = 0.589] coronary cusps), eccentricities (1.08 vs. 1.07; p = 0.9550), and angles (except the right [3.9 degrees vs. 6.3 degrees; p = 0.003] and left [3.6 degrees vs. 6.0 degrees; p = 0.007]) were similar between bicuspid and tricuspid patients. Hemodynamics, stroke, and mortality were similar at 1 year. Conclusion Despite challenging bicuspid anatomy of the aortic valve , our comprehensive CT analysis supports similar THV geometry between patients with bicuspid and tricuspid AS undergoing TAVR using the SAPIEN 3 THV in low-risk patients. This translated to excellent short-term clinical outcomes and THV hemodynamics in both aortic valve morphologies. Trial registry NCT02628899 , https://clinicaltrials.gov/ct2/show/NCT02628899 .
- Published
- 2021
35. Clinical impact and predictors of troponin elevation in patients with COVID-19
- Author
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Jonathan Abramowitz, Ron Waksman, Toby Rogers, Hayder Hashim, Lowell F. Satler, Brian J. Forrestal, Brian C. Case, Itsik Ben-Dor, Charan Yerasi, Giorgio A. Medranda, Corey Shea, Cheng Zhang, and Hank Rappaport
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,macromolecular substances ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,In patient ,Hospital Mortality ,030212 general & internal medicine ,Pandemics ,Aged ,Retrospective Studies ,Aged, 80 and over ,Mechanical ventilation ,biology ,business.industry ,COVID-19 ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Troponin ,Elevation (emotion) ,Concomitant ,Myocardial injury ,Cohort ,Troponin elevation ,Cardiology ,biology.protein ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background Cardiac involvement in coronavirus disease 2019 (COVID-19) is known, manifested by troponin elevation. Studies in the initial phase of the pandemic demonstrated that these patients tended to have a worse prognosis than patients without myocardial injury . We sought to evaluate the clinical impact of significant troponin elevation in COVID-19-positive patients, along with predictors of poor outcomes, over the span of the pandemic to date. Methods We analyzed COVID-19-positive patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the pandemic (March 1–June 30, 2020). We compared clinical course and outcomes based on the presence of troponin elevation and identified predictors of mortality. Results The cohort included 2716 COVID-19-positive admitted patients for whom troponin was drawn. Of these patients, 250 had troponin elevation (≥1.0 ng/mL). In the troponin-elevation arm, the minimum troponin level was 1.9 ± 8.82 ng/mL; maximum elevation was 10.23 ± 31.07 ng/mL. The cohort's mean age was 68.0 ± 15.0 years; 52.8% were men. Most (68.5%) COVID-19-positive patients with troponin elevation were African American. Patients with troponin elevation tended to be older, with more co-morbidities, and most required mechanical ventilation . In-hospital mortality was significantly higher (48.4%) in COVID-19-positive patients with concomitant troponin elevation than without troponin elevation (12.2%; p Conclusion COVID-19 patients with troponin elevation are at higher risk for mechanical ventilation and mortality. Efforts should focus on early recognition, evaluation, and intensifying care of these patients.
- Published
- 2021
36. One-Year Outcomes After Treatment of Ostial In-Stent Restenosis in Left Circumflex Versus Left Anterior Descending or Right Coronary Artery
- Author
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Toby Rogers, Brian J. Forrestal, Anees Musallam, Itsik Ben-Dor, Rebecca Torguson, Hayder Hashim, Brian C. Case, Evan Shlofmitz, Ron Waksman, Jaffar M. Khan, Chava Chezar-Azerrad, Cheng Zhang, Corey Shea, Gary S. Mintz, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Charan Yerasi, and Nauman Khalid
- Subjects
Atherectomy, Coronary ,Male ,medicine.medical_specialty ,Brachytherapy ,Myocardial Infarction ,Hemorrhage ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Lesion ,Coronary Restenosis ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Restenosis ,Recurrence ,Internal medicine ,medicine.artery ,Diabetes mellitus ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Circumflex ,Hospital Mortality ,Angioplasty, Balloon, Coronary ,Ultrasonography, Interventional ,Aged ,Proportional Hazards Models ,business.industry ,Drug-Eluting Stents ,medicine.disease ,Stroke ,Treatment Outcome ,Bypass surgery ,Metals ,Right coronary artery ,Cardiology ,Female ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
The prognosis of left circumflex (LC) versus non-LC in-stent restenosis (ISR) ostial lesions following treatment has not been assessed. We aimed to assess this prognosis. Anecdotally, treatment of ostial LC ISR has been associated with high recurrence rates. We performed a retrospective analysis of patients from our institution who underwent coronary intervention of an ostial ISR lesion between 2003 and 2018. The primary endpoint was target lesion revascularization (TLR) and major adverse cardiovascular events (MACE). Overall, 563 patients underwent ostial ISR lesion intervention, 144 for an ostial LC ISR lesion. Compared to patients with ostial ISR in non-LC lesions, patients with ostial LC ISR were older, had higher rates of diabetes mellitus and previous coronary bypass surgery. At 1-year follow-up, TLR-MACE rates were 26.6% in the LC group versus 18.4% in the non-LC group (p = 0.036). The TLR rate was also higher in the LC group compared to the non-LC group (p = 0.0498). Univariate and multivariate analyses demonstrated a higher TLR-MACE rate for LC versus non-LC ostial ISR lesions. In conclusion, our study shows increased event rates after treatment of LC versus non-LC ISR lesions. Further studies should be done to assess the optimal treatment approach for ostial LC ISR.
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- 2021
37. Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction
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Tim A. Fischell, Wilson Mathias, Ravinay Bhindi, Adrian P. Banning, Luuk C. Otterspoor, Nico H.J. Pijls, Navin K. Kapur, Gregg W. Stone, Henrique Barbosa Ribeiro, Aloke V. Finn, Hector M. Garcia-Garcia, Charan Yerasi, Renu Virmani, Flavio Ribichini, Jonathan L Ciofani, Roberto Scarsini, Borja Ibanez, Jorge Nuche, Giovanni Luigi De Maria, Robert S. Schwartz, and Yu Sato
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Microvascular injury ,Shock, Cardiogenic ,Infarction ,Myocardial Reperfusion ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Infarct size ,Ischaemia-reperfusion injury ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,ST segment ,cardiovascular diseases ,030212 general & internal medicine ,Embolization ,Myocardial infarction ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,General Medicine ,Device-based therapies ,medicine.disease ,Treatment Outcome ,ST-elevation myocardial infarction ,Heart failure ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Reperfusion injury - Abstract
Primary percutaneous coronary intervention (PPCI) has dramatically changed the outcome of patients with ST-elevation myocardial infarction (STEMI). However, despite improvements in interventional technology, registry data show little recent change in the prognosis of patients who survive STEMI, with a significant incidence of cardiogenic shock, heart failure, and cardiac death. Despite a technically successful PPCI procedure, a variable proportion of patients experience suboptimal myocardial reperfusion. Large infarct size and coronary microvascular injury, as the consequence of ischaemia–reperfusion injury and distal embolization of atherothrombotic debris, account for suboptimal long-term prognosis of STEMI patients. In order to address this unmet therapeutic need, a broad-range of device-based treatments has been developed. These device-based therapies can be categorized according to the pathophysiological pathways they target: (i) techniques to prevent distal atherothrombotic embolization, (ii) techniques to prevent or mitigate ischaemia/reperfusion injury, and (iii) techniques to enhance coronary microvascular function/integrity. This review is an overview of these novel technologies with a focus on their pathophysiological background, procedural details, available evidence, and with a critical perspective about their potential future implementation in the clinical care of STEMI patients.
- Published
- 2021
38. LAMPOON techniques to prevent or manage left ventricular outflow tract obstruction in transcatheter mitral valve replacement
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Itsik Ben-Dor, Charan Yerasi, Brian C. Case, Adam B Greenbaum, Brian J. Forrestal, Jaffar M. Khan, John Lisko, Norihiko Kamioka, Toby Rogers, Lowell F. Satler, Vasilis C. Babaliaros, Ron Waksman, and Robert J. Lederman
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Art of Operative Techniques ,High mortality ,Mitral valve replacement ,Ventricular outflow tract obstruction ,030204 cardiovascular system & hematology ,Surgical risk ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Internal medicine ,Anterior mitral leaflet ,medicine ,Cardiology ,cardiovascular system ,Ventricular outflow tract ,Surgery ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Mitral valve leaflet - Abstract
Transcatheter mitral valve replacement (TMVR) is a therapeutic option for patients with severe mitral disease who are deemed inoperable due to their overall surgical risk. The close relationships between the left ventricular outflow tract (LVOT) and the anterior mitral valve leaflet can lead to LVOT obstruction, a common complication with high mortality. Predicting and preventing LVOT obstruction is therefore essential, prior to TMVR. Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN (LAMPOON) is a transcatheter electrosurgical technique to split the anterior mitral valve leaflet immediately prior to TMVR. The technique has been studied in a prospective clinical trial and has evolved with many iterations for specific anatomies. In this review, we discuss the different LAMPOON techniques to prevent and treat LVOT obstruction.
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- 2021
39. Review of Imaging and Physiology Late Breaking Trials From the TCT Connect 2020 Virtual Meeting
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Chava Chezar-Azerrad, Giorgio A. Medranda, Brian C. Case, Jason P. Wermers, Natalie Morrison, Charan Yerasi, Brian J. Forrestal, and Ron Waksman
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medicine.medical_specialty ,business.industry ,MEDLINE ,Cardiology ,Medicine ,Humans ,Medical physics ,General Medicine ,Coronary Artery Disease ,Cardiology and Cardiovascular Medicine ,business ,Article - Abstract
Highlights • ACC Scientific Sessions 2020 shared the latest research in cardiology. • We highlight results from 14 late-breaking trials. • Areas covered include TAVR, coronary, and peripheral artery disease.
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- 2020
40. Optical Coherence Tomography based treatment approach for patients with Acute Coronary Syndrome
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Giovanni Luigi De Maria, Giorgio A. Medranda, Ron Waksman, Brian C. Case, Charan Yerasi, Hayder Hashim, Evan Shlofmitz, Solomon Beyene, Brian J. Forrestal, Itsik Ben-Dor, Carlos M. Campos, Hector M. Garcia-Garcia, Kayode O. Kuku, Rodrigo Barriola, Christos V Bourantas, Chava Chezar-Azerrad, Gebremedhin D. Melaku, and Kazuhiro Dan
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,genetic structures ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Optical coherence tomography ,Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Thrombosis ,General Medicine ,medicine.disease ,eye diseases ,Plaque, Atherosclerotic ,sense organs ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence - Abstract
Areas covered:In this review, we outline the underlying causes of acute coronary syndrome (ACS) as evaluated by optical coherence tomography (OCT). We report both the definitions of each mechanism and its frequency as reported in the literature to date. Finally, we present an algorithm based on the findings in the review that gives an outlined approach to perform intervention on ACS patients.Expert opinion:Although the most common and most accepted intervention in ACS cases is stent implantation, data suggest a stentless approach in cases of plaque erosion, which generally occurs in younger patients presenting with an acute coronary syndrome that have TIMI flow of 2/3 and either a small or large burden of thrombus and underlying stenosis of less than 50%.
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- 2020
41. Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve
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Gaby Weissman, John Wang, Teshome Deksissa, Cheng Zhang, Brian C. Case, Toby Rogers, Brian J. Forrestal, Lowell F. Satler, Corey Shea, Charan Yerasi, Itsik Ben-Dor, Ron Waksman, Christian Shults, Syed Z. Ali, Jaffar M. Khan, and Rebecca Torguson
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medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Computed tomography ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Tomography ,medicine.diagnostic_test ,business.industry ,Stent ,Aortic Valve Stenosis ,United States ,Valve in valve ,Treatment Outcome ,Coronary Occlusion ,Coronary occlusion ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Feasibility Studies ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The supra-annular leaflet position and tall stent frame of the self-expanding Evolut PRO or Evolut PRO+ transcatheter heart valves (THVs) may cause coronary occlusion during transcatheter aortic valve replacement (TAVR)-in-TAVR and present challenges for future coronary access. We sought to evaluate the risk of TAVR-in-TAVR with Evolut PRO or Evolut PRO+ THVs and the feasibility of future coronary access. Methods: The CoreValve Evolut PRO Prospective Registry (EPROMPT; NCT03423459) prospectively enrolled patients with symptomatic severe aortic stenosis to undergo TAVR using a commercially available latest generation self-expanding THV at 2 centers in the United States. Computed tomography was performed 30 days after TAVR, which we used to simulate TAVR-in-TAVR with a second Evolut PRO or Evolut PRO+ THV and evaluate for risk of coronary obstruction and feasibility of future coronary access. Results: Eighty-one patients enrolled with interpretable computed tomography are reported herein. Computed tomography simulation predicted sinus of Valsalva sequestration and resultant coronary obstruction during future TAVR-in-TAVR in up to 23% of patients. Computed tomography simulation predicted that the position of the pinned THV leaflets would hinder future coronary access in up to 78% of patients after TAVR-in-TAVR. Conclusions: Further THV design improvements and leaflet modification strategies are needed to mitigate the risk of coronary obstruction during TAVR-in-TAVR with self-expanding THVs and to facilitate future coronary access. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03423459.
- Published
- 2020
42. Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta ('elephant head'): Impact on fluoroscopy time and contrast use
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Hayder Hashim, Ron Waksman, Brian C. Case, Yuefeng Chen, Evan Shlofmitz, Brian J. Forrestal, Charan Yerasi, Jaffar M. Khan, Nauman Khalid, Chava Chezar-Azerrad, and Anees Musallam
- Subjects
Coronary angiography ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Head impact ,media_common.quotation_subject ,Elephants ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Contrast (vision) ,Fluoroscopy ,Thoracic aorta ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,030212 general & internal medicine ,media_common ,Aorta ,medicine.diagnostic_test ,business.industry ,General Medicine ,Catheter ,Treatment Outcome ,Angiography ,Radial Artery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Objectives Assess the impact on fluoroscopy time and contrast use in patients with tortuous brachiocephalic/thoracic aortas undergoing right transradial coronary angiography (RTCA) and provide strategies to manage. Background Unfavorable anatomy with severe brachiocephalic/thoracic tortuosity, referred to as an "elephant head," remains a significant obstacle for RTCA. Methods We reviewed the coronary angiograms of patients who underwent RTCA and had tortuous aortas. Angiography was attempted first using a universal catheter (Tiger) and switched to a left coronary specific catheter (Judkins Left [JL]) if challenging. Fluoroscopy time, contrast volume, and greatest distance from the patient's midline to the catheter in the aorta were recorded. Results Forty-nine patients (62.6 ± 12.0 years, 69.4% male) were included. Fifteen (30.6%) patients underwent successful angiography with a Tiger catheter; 34 (69.4%) patients required switching to JL catheter. The average distance of Tiger catheters to the midline of the spine was 0.78 ± 0.41 cm versus 1.28 ± 0.44 cm (p = .001) in JL catheters. Tiger catheter use resulted in less fluoroscopy time (6.48 ± 4.73 min) and contrast use (58.87 ± 43.53 ml) than in cases switched to JL (13.26 ± 10.76 min [p = .026]; 86.5 ± 69.95 ml [(p = .017]). Conclusions For patients undergoing RTCA with significant brachiocephalic/thoracic aorta tortuosity, "elephant head," a Tiger catheter can be used efficiently for curvatures 1 cm, operators should consider immediately switching to a JL catheter.
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- 2020
43. Usefulness of Antiplatelet Therapy After Transcatheter Aortic Valve Implantation
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Lowell F. Satler, Toby Rogers, Brian J. Forrestal, Itsik Ben-Dor, Ron Waksman, Gary S. Mintz, Charan Yerasi, and Brian C. Case
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medicine.medical_specialty ,animal structures ,Transcatheter aortic ,Hemorrhage ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cause of Death ,medicine ,Humans ,030212 general & internal medicine ,Heart valve ,Endothelium ,Mortality ,Evidence-Based Medicine ,Aspirin ,business.industry ,Dual Anti-Platelet Therapy ,Expert consensus ,Thrombosis ,Aortic Valve Stenosis ,medicine.disease ,Clopidogrel ,Stroke ,Regimen ,medicine.anatomical_structure ,Cardiology ,Observational study ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
The rationale for dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI) is to facilitate endothelialization of metallic struts of the transcatheter heart valve and to prevent thrombosis that could lead to thromboembolic events. Based on expert consensus, current societal guidelines recommend DAPT for 1 to 6 months after TAVI with weak evidence. Although the pivotal TAVI trials mandated this regimen, the evidence for the efficacy of DAPT to prevent transcatheter heart valve thrombosis is limited to 3 small trials and a handful of observational studies. Multiple coronary trials have demonstrated that DAPT is associated with increased bleeding in comparison with single antiplatelet therapy, especially in elderly patients. TAVI patients are predominantly elderly and frequently have risk factors that predispose them to bleeding. Herein, we summarize the evidence for antiplatelet therapy after TAVI and explore the theoretical benefit of DAPT to prevent thromboembolic events versus the risk of increased bleeding.
- Published
- 2020
44. Abstract 14527: Utility of Routine Invasive Coronary Angiography Prior to Transcatheter Aortic Valve Replacement
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Toby Rogers, Chava Chezar Azerrad, Sant Kumar, Itsik Ben-Dor, Lowell F. Satler, Charan Yerasi, Anees Musallam, Brian Case, Brian J. Forrestal, Joshua Hahm, Ron Waksman, and Hayder Hashim
- Subjects
Aortic valve ,medicine.medical_specialty ,High prevalence ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,medicine.disease ,Invasive coronary angiography ,Coronary artery disease ,Stenosis ,medicine.anatomical_structure ,Valve replacement ,Physiology (medical) ,Internal medicine ,Concomitant ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Despite the high prevalence of CAD in patients with severe aortic stenosis (AS), the optimal management of concomitant coronary artery disease (CAD) before trasncatheter aortic valve replacement (TAVR) remains controversial. Hypothesis: To characterize the contemporary, real-world burden of CAD in contemporary TAVR patients and to evaluate revascularization practices at a high-volume center in the United States. Methods: Analysis of all adult patients referred for TAVR at our center between January 2019 and January 2020. Presence of significant coronary artery disease (stenosis >50%) and subsequent management (medical therapy versus revascularization) were recorded. Presenting symptoms, use of non-invasive and invasive ischemia testing and pre-TAVR computed tomography (CT) imaging were all analyzed. Results: A total of 394 patients with severe AS were referred to our institution for TAVR. Thirty-nine patients (9.9%) instead underwent surgical aortic valve replacement (SAVR), of which only 5 (1.3%) underwent SAVR plus coronary artery bypass surgery. Of the remaining 355 patients (77.3 ± 9.3 years old and 59.7% males), 218 patients (61.4%) had insignificant CAD. Of the 137 patients (38.6%) with significant CAD, only 30 (8.5%) underwent percutaneous coronary intervention (PCI). Of these, less than half had anginal symptoms, a third had CAD in proximal segments and a third underwent ischemia testing prior to PCI. Pre-TAVR CT accurately identified significant CAD in 28/30 patients (93.3%) who ultimately underwent PCI. Conclusions: Only 1 in 25 contemporary TAVR patients had significant CAD and anginal symptoms requiring intervention, questioning the utility of routine invasive coronary angiography before TAVR. A Heart Team approach integrating anginal symptoms and ischemia testing is needed to guide the need, timing and strategy of revascularization. The pre-TAVR CT images could identify significant proximal segment CAD needing PCI.
- Published
- 2020
45. Abstract 16040: High-risk Percutaneous Coronary Intervention Without Mechanical Circulatory Support in Acute Coronary Syndrome
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Brian J. Forrestal, Itsik Ben-Dor, Nelson L. Bernardo, Yuefeng Chen, Lowell F. Satler, Hayder Hashim, Brian Case, Charan Yerasi, Cheng Zhang, Chava Chezar Azerrad, Toby Rogers, Ron Waksman, Nauman Khalid, Anees Musallam, Corey Shea, Evan Shlofmitz, and Hasan Javed
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,Interventional cardiology ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,medicine.disease ,Physiology (medical) ,Internal medicine ,Circulatory system ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Background: Use of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (HRPCI) remains controversial with lack of randomized evidence and associated complication risks from these devices. We investigated whether performing HRPCI without elective MCS in patients with acute coronary syndrome (ACS) is safe and feasible. Methods: A single-center, retrospective analysis was done for patients presenting with ACS meeting HRPCI criteria (defined by Interventional Council of American College of Cardiology) including unprotected left main disease, last remaining conduit, left ventricular ejection fraction Results: From 2003-2018, 1992 patients (2887 lesions) with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) and 920 patients (1328 lesions) with ST-segment elevation myocardial infarction (STEMI) underwent HRPCI. The study population had 64.8% men and 52.9% Caucasians in UA/NSTEMI-group and 64.3% men and 53.7% Caucasians in STEMI-group. Mean age for UA/NSTEMI and STEMI patients were 68.6+/-12.69 and 64.52+/-13.54 years respectively. Procedural success was achieved in 96.5% of UA/NSTEMI and 97.9% of STEMI patients. In-hospital and 30-day all-cause mortality was 2.1% for UA/NSTEMI and 4.7% for STEMI patients. Bailout MCS was required in 2.4% of UA/NSTEMI and 9.9% of STEMI patients. Rates of major complications for UA/NSTEMI and STEMI were low, except for renal failure (Panel A). Panel B provides HRPCI criteria distribution. Conclusions: HRPCI without elective MCS is safe and feasible in majority of ACS patients challenging the current practices of professional societies. A randomized trial comparing unprotected vs. protected HRPCI for ACS patients is warranted to identify patients that would benefit from MCS.
- Published
- 2020
46. Abstract 16624: Gender Disparities Based on Time to Revascularization in the Treatment of Non-st-segment Elevation Myocardial Infarction: An Analysis of 748,439 Nstemi Admissions
- Author
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Brian Case, Brian J. Forrestal, Sarahfye Dolman, Ron Waksman, Charan Yerasi, Yanying Wang, William S. Weintraub, and Joshua Hahm
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Elevation ,Revascularization ,medicine.disease ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,ST segment ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Multiple studies on Non-ST-segment elevation myocardial infarction (NSTEMI) have shown that women tend to have delayed revascularization, with associated worse outcomes, when compared to men. However, there are no studies to date, evaluating the clinical characteristics and outcomes of men versus (vs.) women based on time to revascularization. Methods: The study cohort was obtained from the 2016 Nationwide Readmissions Database. We used the International Classification of Diseases, Tenth Revision, to identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, mortality and 30-day readmissions rates based on gender and time to revascularization were extracted. Results: In 2016, there were a total of 748,439 weighted admissions for NSTEMI (57% men and 43% women). Compared to men, women were older and had higher percentage of baseline comorbidities. Women tended to be managed less invasively with only 45% undergoing coronary angiogram as compared to 54% in men (p Conclusions: Currently, there exists wide disparity among men and women in the treatment of NSTEMI. Women tend to have worse outcomes as the revascularization gets delayed. Randomized clinical trials are needed to evaluate if a strategy of urgent revascularization (
- Published
- 2020
47. Abstract 16860: Racial Disparity in COVID-19 Patients With Concomitant Myocardial Injury
- Author
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Brian Case, Chava Chezar Azerrad, Itsik Ben-Dor, Charan Yerasi, Hayder Hashim, Nelson L. Bernardo, Brian J. Forrestal, Lowell F. Satler, and Ron Waksman
- Subjects
medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,biology ,Racial disparity ,business.industry ,Troponin ,Physiology (medical) ,Internal medicine ,Concomitant ,Cardiology ,biology.protein ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Cardiac involvement in Coronavirus Disease 2019 (COVID-19) is common. Estimated that 30% of patients hospitalized with COVID-19 have an elevated troponin and these patients have worse prognosis when compared to patients without myocardial injury. Hypothesis: The purpose of this study is to investigate if there is any racial disparity in the in-hospital clinical outcomes of COVID-19 patients with myocardial injury. Methods: This study included all COVID-19 positive patients within the MedStar Health System (11 acute hospitals in the DC/Maryland/Virginia area) with an elevation of troponin and a diagnosis of either ST-Elevation Myocardial Infarction (STEMI) or Non-ST-Elevation Myocardial Infarction (NSTEMI) based on International Classification of Diseases-10. Results: There was 3,589 COVID-19 admissions between March to June 2020. Of these, a total of 75 COVID-19 patients had either a STEMI or NSTEMI. Overall mean age was 70.9 ± 14.6 and 54.7% were male. Of these patients, the majority were African American (51; 68%) followed by Caucasians (15; 20%). The overall in-hospital mortality rate was 24.3%, with African Americans having a higher rate (73.7%) as compared to Caucasians (15.8%) p 0.05. Furthermore, African Americans trended toward having higher rates of intensive care unit (ICU) admissions, intubation, and longer ICU stays; however, not statistically significant. Despite African Americans appearing to be a sicker cohort, inflammatory markers and myocardial involvement did not differ between the two groups (Table 1). Conclusions: Patients with COVID-19 and concomitant myocardial injury have a high in-hospital mortality rate. There is a racial disparity with African Americans having a higher rate of in-hospital mortality. However, inflammatory markers and myocardial injury does not differ between the two groups meaning other unidentified underlying issue may be the etiology for a sicker cohort in African Americans.
- Published
- 2020
48. Utility of Routine Invasive Coronary Angiography Prior to Transcatheter Aortic Valve Replacement
- Author
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Brian C. Case, Ron Waksman, Joshua Hahm, Lowell F. Satler, Brian J. Forrestal, Chava Chezar-Azerrad, Itsik Ben-Dor, Toby Rogers, Anees Musallam, Sant Kumar, Hayder Hashim, and Charan Yerasi
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Revascularization ,Coronary Angiography ,Coronary artery disease ,Angina ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Percutaneous coronary intervention ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Stenosis ,Treatment Outcome ,Aortic Valve ,Conventional PCI ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background/purpose Despite the high prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS), the optimal management of concomitant CAD, including revascularization before transcatheter aortic valve replacement (TAVR), remains controversial. Contemporary, real-world practice patterns have not yet been described. We aimed to characterize the burden of CAD in contemporary TAVR patients and evaluate revascularization practices at a high-volume center. Methods/materials We retrospectively analyzed all adult patients referred for TAVR at our center between January 2019 and January 2020. Presence of significant CAD and subsequent management were recorded. Presenting symptoms, use of non-invasive and invasive ischemia testing, and pre-TAVR computed tomography (CT) imaging were analyzed. Results A total of 394 patients with severe AS were referred for TAVR. Thirty-nine patients (9.9%) instead underwent surgery, of whom only 5 (1.3%) received coronary artery bypass grafting . Of the remaining 355 patients, 218 patients (61.4%) had insignificant CAD. Of the 137 patients (38.6%) with significant CAD, only 30 (8.5%) underwent percutaneous coronary intervention (PCI). Of these, less than half had anginal symptoms, a third had CAD in proximal segments, and a third underwent ischemia testing before PCI. Pre-TAVR CT accurately identified significant CAD in 28/30 patients (93.3%) who underwent PCI. Conclusions Only 1 in 25 contemporary TAVR patients had significant CAD and angina requiring intervention, calling into question the utility of routine invasive coronary angiography before TAVR. A Heart Team approach integrating anginal symptoms, ischemia testing and possibly pre-TAVR CT is needed to guide the need, timing, and strategy of revascularization.
- Published
- 2020
49. Cangrelor vs. glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention
- Author
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Itsik Ben-Dor, Chava Chezar-Azerrad, Cheng Zhang, Hector M. Garcia-Garcia, Charan Yerasi, Giorgio A. Medranda, Brian J. Forrestal, Brian C. Case, Nelson L. Bernardo, Lowell F. Satler, Ron Waksman, Hayder Hashim, and Corey Shea
- Subjects
Male ,Gastrointestinal bleeding ,medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Hemorrhage ,Platelet Glycoprotein GPIIb-IIIa Complex ,030204 cardiovascular system & hematology ,Hematocrit ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Hematoma ,Cangrelor ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Acute Coronary Syndrome ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Length of Stay ,Middle Aged ,medicine.disease ,Adenosine Monophosphate ,chemistry ,Glycoprotein IIb/IIIa inhibitors ,Conventional PCI ,Cardiology ,Purinergic P2Y Receptor Antagonists ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Gastrointestinal Hemorrhage ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Background To date, there are no real-world studies comparing cangrelor to glycoprotein IIb/IIIa inhibitors (GPI) during percutaneous coronary intervention (PCI). Thus, we performed this study to evaluate the safety and effectiveness of cangrelor compared to GPI during PCI. Methods We identified patients who underwent PCI at our institution who received either cangrelor or GPI during PCI. Patients already on GPI or cangrelor prior to PCI or who received both cangrelor and GPI were excluded. Baseline demographics and clinical outcomes were extracted. Major bleeding is defined as a composite of major hematoma >4 cm, hematocrit drop >15, and gastrointestinal bleeding. Results A total of 2072 patients received adjunctive antiplatelet therapy during PCI (cangrelor [n=478]; GPI [n=1594]). Patients’ mean age was 61±12 years. Most (66%) presented with acute coronary syndrome. Patients who received cangrelor were older and had a higher percentage of acute coronary syndrome and lower baseline hematocrit in comparison with patients who received GPI. Procedural success was achieved in 94% of patients, with no difference between groups. Major bleeding events (1.7% vs. 5.1%, P=.001), any vascular complication rates, and hospital length of stay were significantly lower in the cangrelor group. In-hospital ischemic events did not differ between groups. On regression analysis, patients on cangrelor were noted to have significantly lower major bleeding events (OR 0.23; 95% CI, 0.09-0.59). Conclusions Balancing ischemic and bleeding risks with adjunctive antiplatelet drugs is of prime importance during PCI. Our real-world analysis shows that cangrelor is safe and effective when compared to GPI during PCI.
- Published
- 2020
50. Characteristics and Outcomes of Patients Undergoing Coronary Intervention for In-Stent Restenosis
- Author
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Chava Chezar-Azerrad, Brian Case, Brian J. Forrestal, Gheorghe Doros, Giorgio A. Medranda, Charan Yerasi, Itsik Ben-Dor, Cheng Zhang, Nelson L. Bernardo, Lowell F. Satler, Gary S. Mintz, Corey Shea, Hayder Hashim, Ron Waksman, and Toby Rogers
- Subjects
medicine.medical_specialty ,business.industry ,Intervention (counseling) ,Medicine ,General Medicine ,In stent restenosis ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2021
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