87 results on '"Sandra Weiss"'
Search Results
2. Molecular Mechanism of Sirtuin 1 Modulation by the AROS Protein
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Sandra Weiss, Ramona S. Adolph, Kristian Schweimer, Andrea DiFonzo, Marat Meleshin, Mike Schutkowski, and Clemens Steegborn
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Cell Nucleus ,Organic Chemistry ,General Medicine ,activator ,deacetylase ,Sirt1 ,inhibitor ,regulation ,Catalysis ,Computer Science Applications ,Inorganic Chemistry ,Histones ,Sirtuin 1 ,Humans ,Sirtuins ,Physical and Theoretical Chemistry ,Molecular Biology ,Spectroscopy ,Transcription Factors - Abstract
The protein lysine deacylases of the NAD+-dependent Sirtuin family contribute to metabolic regulation, stress responses, and aging processes, and the human Sirtuin isoforms, Sirt1-7, are considered drug targets for aging-related diseases. The nuclear isoform Sirt1 deacetylates histones and transcription factors to regulate, e.g., metabolic adaptations and circadian mechanisms, and it is used as a therapeutic target for Huntington’s disease and psoriasis. Sirt1 is regulated through a multitude of mechanisms, including the interaction with regulatory proteins such as the inhibitors Tat and Dbc1 or the activator AROS. Here, we describe a molecular characterization of AROS and how it regulates Sirt1. We find that AROS is a partly intrinsically disordered protein (IDP) that inhibits rather than activates Sirt1. A biochemical characterization of the interaction including binding and stability assays, NMR spectroscopy, mass spectrometry, and a crystal structure of Sirtuin/AROS peptide complex reveal that AROS acts as a competitive inhibitor, through binding to the Sirt1 substrate peptide site. Our results provide molecular insights in the physiological regulation of Sirt1 by a regulator protein and suggest the peptide site as an opportunity for Sirt1-targeted drug development.
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- 2022
3. Mobile Medical Clinics in the United States Post-Affordable Care Act: An Integrative Review
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Angela Coaston, Soo-Jeong Lee, Julene Johnson, Marcella Hardy-Peterson, Sandra Weiss, and Caroline Stephens
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Adult ,Leadership and Management ,Health Policy ,Patient Protection and Affordable Care Act ,Chronic Disease ,Public Health, Environmental and Occupational Health ,Humans ,Child ,Mobile Health Units ,United States - Abstract
Despite changes brought about by the 2010 Affordable Care Act (ACA), millions of individuals are still unable to access health care in the United States. Mobile medical clinics have been an invisible force of care delivery for vulnerable and marginalized populations for decades; however, little is known about their impact post-ACA. Guided by the Anderson Behavioral Model, the purpose of this article was to review and critique the state of the current literature about mobile medical clinics in the United States since 2010. Following Whittemore and Knafl's integrative review methodology, the search was conducted in 6 databases and delivered 1934 results; 341 articles were removed as duplicates. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 2 independent reviewers screened and adjudicated the remaining titles, abstracts, and full-texts, yielding 12 articles in the final review. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the quality of the articles. Studies revealed variation in quality, study design, and location; and diversity of chronic diseases and populations addressed (eg, children with asthma, complementary alternative medicine use with children, adults with diabetes and hypertension, patients with chronic disease with an emphasis on the patient experience, utilization patterns in migrant farmers). Mobile medical clinics provide care for the prevention, treatment, and management of chronic illness and their wide geographic spread confirms their broad use across the United States. They provide a return on investment through emergency room avoidance, decreasing hospital length of stay, and improving chronic disease management.
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- 2022
4. 0059 Does Discrimination Moderate the Relationship between Insomnia and Telomere Length in Older Adults from Three Racial/Ethnic Groups?
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Greg Roussett, Aric Prather, Margaret Wallhagen, and Sandra Weiss
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Physiology (medical) ,Neurology (clinical) - Abstract
Introduction Both insomnia and discrimination have been associated with adverse physical and mental health outcomes. Evidence suggests that discrimination may moderate the effects of sleep on telomeres, DNA sequences at the end of chromosomes that protect them from degradation. The purpose of this study was to determine the relationship between insomnia and telomere length among older non-latinx white, black, and latinx individuals and whether discrimination moderated this relationship differently based on race or ethnicity. Methods This study is a secondary analysis from the Health and Retirement Study, a longitudinal project sponsored by the National Institute on Aging. Our analysis consisted of 3,205 US participants who provided information on sleep problems as well as salivary samples from which telomere data were assayed. We computed a linear regression to examine the relationship between insomnia symptoms and telomere length in each racial/ethnic group, including interaction terms to assess moderating effects of discrimination. Results Insomnia symptoms were associated with shortened telomere length among non-latinx white participants (β -0.046, p=0.015, [-0.06, -0.01]). Discrimination had a moderating effect between insomnia symptoms and telomere length among black participants (β -0.28, p=0.045, [-0.33, -0.00]). Analyses remained significant after adjusting for age, medical co-morbidities, smoking status, and a history of depression. Conclusion Our results suggest that symptoms of insomnia may contribute to telomere erosion, with potentially adverse effects on genomic integrity. For black individuals, those who experienced discrimination were at greater risk of telomere damage associated with insomnia. Support (If Any) Funding has been made available by the NIH, granted to UCSF School of Nursing Biobehavioral Research Training Program in Symptom Science (NIH: T32 NRO16920).
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- 2022
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5. Use of prasugrel and clinical outcomes in African-American patients treated with percutaneous coronary intervention for acute coronary syndromes
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Brian A. Baker, Samir Kapadia, Bimmer E. Claessen, Sameer Bansilal, Zhen Ge, Timothy Henry, Stuart J. Pocock, Roxana Mehran, Usman Baber, Sunil V. Rao, Craig Strauss, Stuart Keller, William S. Weintraub, Samantha Sartori, Kanhaiya L. Poddar, Clayton Snyder, Annapoorna Kini, Melissa Aquino, Birgit Vogel, Sandra Weiss, Catalin Toma, Brent Muhlestein, Mark B. Effron, Michela Faggioni, Anthony C. DeFranco, and Jaya Chandrasekhar
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Male ,Time Factors ,Prasugrel ,medicine.medical_treatment ,Comorbidity ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Prevalence ,Prospective Studies ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,education.field_of_study ,Incidence ,Age Factors ,General Medicine ,Middle Aged ,Clopidogrel ,Race Factors ,Treatment Outcome ,Female ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,Acute coronary syndrome ,Population ,Hemorrhage ,Risk Assessment ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Sex Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Acute Coronary Syndrome ,Healthcare Disparities ,education ,Aged ,business.industry ,Percutaneous coronary intervention ,Health Status Disparities ,medicine.disease ,United States ,Black or African American ,Conventional PCI ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,Kidney disease - Abstract
OBJECTIVE: To investigate the use of prasugrel after percutaneous coronary intervention (PCI) in African American (AA) patients presenting with acute coronary syndrome (ACS). BACKGROUND: AA patients are at higher risk for adverse cardiovascular outcomes after PCI and may derive greater benefit from the use of potent antiplatelet therapy. METHODS: Using the multicenter PROMETHEUS observational registry of ACS patients treated with PCI, we grouped patients by self-reported AA or other races. Clinical outcomes at 90-day and 1-year included non-fatal myocardial infarction (MI), major adverse cardiac events (composite of death, MI, stroke, or unplanned revascularization) and major bleeding. RESULTS: The study population included 2,125 (11%) AA and 17,707 (89%) non-AA patients. AA patients were younger, more often female (46% vs. 30%) with a higher prevalence of diabetes mellitus, chronic kidney disease, and prior coronary intervention than non-AA patients. Although AA patients more often presented with troponin (+) ACS, prasugrel use was much less common in AA vs. non-AA (11.9% vs. 21.4%, respectively, P = 0.001). In addition, the use of prasugrel increased with the severity of presentation in non-AA but not in AA patients. Multivariable logistic regression showed AA race was an independent predictor of reduced use of prasugrel (0.42 [0.37-0.49], P
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- 2019
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6. Use of prasugrel vs clopidogrel and outcomes in patients with and without diabetes mellitus presenting with acute coronary syndrome undergoing percutaneous coronary intervention
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Annapoorna Kini, Mark B. Effron, Samantha Sartori, Stuart J. Pocock, Sunil V. Rao, Craig Strauss, Michela Faggioni, Bimmer E. Claessen, Usman Baber, Samir R. Kapadia, Catalin Toma, Timothy D. Henry, William S. Weintraub, Jaya Chandrasekhar, Brian A. Baker, Anthony C. DeFranco, Stuart Keller, Roxana Mehran, Kanhaiya L. Poddar, Joseph B. Muhlestein, Clayton Snyder, Melissa Aquino, Serdar Farhan, Birgit Vogel, Sandra Weiss, and Sabato Sorrentino
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,medicine.medical_treatment ,Comorbidity ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Internal medicine ,Diabetes Mellitus ,medicine ,Clinical endpoint ,Humans ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Aged ,business.industry ,Unstable angina ,Incidence ,Percutaneous coronary intervention ,Middle Aged ,Prognosis ,medicine.disease ,Clopidogrel ,United States ,Survival Rate ,Purinergic P2Y Receptor Antagonists ,Female ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,Mace ,Follow-Up Studies ,medicine.drug - Abstract
BACKGROUND: Clinical trial data studies suggest superiority of prasugrel over clopidogrel in patients with diabetes. However, the use, safety and efficacy profile of prasugrel in unselected diabetic patients presenting with acute coronary syndromes (ACS) remain unclear. METHODS: PROMETHEUS was a prospective multicenter observational study of 19,919 ACS PCI patients enrolled between 2010 and 2013. The primary endpoint was 90-day major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, stroke or unplanned revascularization. The safety endpoint was bleeding requiring hospitalization. RESULTS: We identified 7580 (38%) subjects with and 12,329 (62%) without diabetes. Diabetic patients were older and had significantly higher rates of cardiovascular risk factors. However, they were less likely to receive prasugrel (18.2% vs. 21.7%). Use of prasugrel did not increase with the severity of clinical presentation in diabetics, whereas, among non-diabetics, prescription of prasugrel was higher in NSTEMI and STEMI compared to unstable angina. The 90-day and 1-year adjusted risk of MACE was greater in diabetics (at 1 year: 22.7% vs. 16.5%; HR 1.22 [1.14-1.33], p
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- 2019
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7. Associations between use of prasugrel vs clopidogrel and outcomes by type of acute coronary syndrome
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Bimmer E. Claessen, Roxana Mehran, Shawn X. Li, Sandra Weiss, Stuart Keller, Zhen Ge, Stuart J. Pocock, Brian A. Baker, George Dangas, Samir R. Kapadia, Timothy D. Henry, Jaya Chandrasekhar, Catalin Toma, Anthony C. DeFranco, Annapoorna Kini, Brent Muhlestein, Usman Baber, Mark B. Effron, Rishi Chandiramani, Sunil V. Rao, Craig Strauss, Samantha Sartori, and Cardiology
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,medicine.medical_treatment ,Hemorrhage ,030204 cardiovascular system & hematology ,Percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Angina, Unstable ,Registries ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Non-ST Elevated Myocardial Infarction ,Aged ,Retrospective Studies ,Unstable angina ,business.industry ,Hematology ,Middle Aged ,medicine.disease ,Clopidogrel ,United States ,Treatment Outcome ,Cardiovascular Diseases ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Mace ,medicine.drug - Abstract
We sought to investigate the utilization of prasugrel and its association with outcomes relative to clopidogrel in three typical subgroups of ACS in a real-world setting. Prasugrel is superior to clopidogrel for reducing risk of ischemic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), but is associated with an increased risk of bleeding complications. PROMETHEUS was a retrospective multicenter observational study of 19,913 ACS patients undergoing PCI from 8 centers in the United States between 2010 and 2013. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, stroke or unplanned revascularization. The study cohort included 3285 (16.5%) patients with ST-segment elevation myocardial infarction (STEMI), 5412 (27.2%) patients with NSTEMI and 11,216 (56.3%) patients with unstable angina (UA). The frequency of prasugrel use at discharge was highest in STEMI and lowest in UA patients, 27.3% versus 22.2% versus 18.9% (p < 0.001). Use of prasugrel vs clopidogrel was associated with a lower rate of MACE in STEMI, NSTEMI, or UA at 1 year, but the differences were attenuated for all groups except for patients with UA (adjusted HR 0.81, 95% CI 0.69–0.94, p = 0.006) after propensity adjusted analysis. After adjustment, there was no difference in bleeding risk between prasugrel and clopidogrel for all groups at 1 year. STEMI patients were more likely to receive prasugrel compared to NSTEMI and UA patients. Prasugrel was associated with reduced adverse outcomes compared with clopidogrel in unadjusted analyses, findings that were largely attenuated upon adjustment and suggest preferential use of prasugrel in low vs high risk patients.
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- 2019
8. Lifestyle management and secondary prevention of coronary artery disease
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Mansoor Ahmad, William S. Weintraub, and Sandra Weiss
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Coronary artery disease ,Secondary prevention ,medicine.medical_specialty ,business.industry ,medicine ,Intensive care medicine ,business ,medicine.disease ,Lifestyle management - Abstract
Cardiovascular disease has been the leading cause of death in industrialized nations since the early 1900s. According to the American Heart Association, there are more than 1 million new and recurrent cardiac events occurring each year. Those with a history of cardiac ischaemic events have a high risk of recurrent events; however, the death rate from coronary artery disease declined from 1995 to 2005 by 26%. Thus, the burden of chronic non-fatal coronary artery disease remains high and therefore underscores the importance of secondary prevention measures. This chapter focuses on lifestyle modification, which is considered a major component of secondary prevention.
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- 2021
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9. Associations Between Complex PCI and Prasugrel or Clopidogrel Use in Patients With Acute Coronary Syndrome Who Undergo PCI: From the PROMETHEUS Study
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Zhen Ge, George Dangas, Stuart J. Pocock, Joseph B. Muhlestein, Catalin Toma, Samantha Sartori, Melissa Aquino, Samir R. Kapadia, Serdar Farhan, Brian A. Baker, Sunil V. Rao, Craig Strauss, Mark B. Effron, Jaya Chandrasekhar, Birgit Vogel, Sandra Weiss, Timothy D. Henry, Sabato Sorrentino, Stuart Keller, Anthony C. DeFranco, William S. Weintraub, Roxana Mehran, Usman Baber, and Annapoorna Kini
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Ticlopidine ,Prasugrel ,Thienopyridine ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Angioplasty, Balloon, Coronary ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Coronary Thrombosis ,Percutaneous coronary intervention ,Middle Aged ,Prognosis ,medicine.disease ,Clopidogrel ,Combined Modality Therapy ,Survival Analysis ,United States ,Treatment Outcome ,surgical procedures, operative ,Multivariate Analysis ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,Mace ,medicine.drug - Abstract
BACKGROUND: Potent P2Y12 inhibitors might offer enhanced benefit against thrombotic events in complex percutaneous coronary intervention (PCI). We examined prasugrel use and outcomes according to PCI complexity, as well as analyzing treatment effects according to thienopyridine type. METHODS: PROMETHEUS was a multicentre observational study that compared clopidogrel vs prasugrel in acute coronary syndrome patients who underwent PCI (n = 19,914). Complex PCI was defined as PCI of the left main, bifurcation lesion, moderate-severely calcified lesion, or total stent length ≥ 30 mm. Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke, or unplanned revascularization. Outcomes were adjusted using multivariable Cox regression for effect of PCI complexity and propensity-stratified analysis for effect of thienopyridine type. RESULTS: The study cohort included 48.9% (n = 9735) complex and 51.1% (n = 10,179) noncomplex patients. Second generation drug-eluting stents were used in 70.1% complex and 66.2% noncomplex PCI patients (P < 0.0001). Complex PCI was associated with greater adjusted risk of 1-year MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.20-1.39; P < 0.001). Prasugrel was prescribed in 20.7% of complex and 20.1% of noncomplex PCI patients (P = 0.30). Compared with clopidogrel, prasugrel significantly decreased adjusted risk for 1-year MACE in complex PCI (HR, 0.79; 95% CI, 0.68-0.92) but not noncomplex PCI (HR, 0.91; 95% CI, 0.77-1.08), albeit there was no evidence of interaction (P interaction = 0.281). CONCLUSIONS: Despite the use of contemporary techniques, acute coronary syndrome patients who undergo complex PCI had significantly higher rates of 1-year MACE. Adjusted magnitude of treatment effects with prasugrel vs clopidogrel were consistent in complex and noncomplex PCI without evidence of interaction.
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- 2018
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10. TCT-228 Prasugrel or Clopidogrel in Patients With Acute Coronary Syndromes With Multivessel Disease: Results From the PROMETHEUS Study
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Sandra Weiss, Sunil V. Rao, Carlo Andrea Pivato, Annapoorna Kini, Timothy D. Henry, George Dangas, Stuart J. Pocock, Johny Nicolas, Zhongjie Zhang, Samir R. Kapadia, William S. Weintraub, Samantha Sartori, Roxana Mehran, Mauro Chiarito, Mark B. Effron, Davide Cao, and Matteo Nardin
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medicine.medical_specialty ,Prasugrel ,business.industry ,Internal medicine ,Cardiology ,medicine ,In patient ,Multivessel disease ,Cardiology and Cardiovascular Medicine ,Clopidogrel ,business ,medicine.drug - Published
- 2021
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11. Associations Between Chronic Kidney Disease and Outcomes With Use of Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
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Michela Faggioni, William S. Weintraub, Melissa Aquino, Serdar Farhan, Samantha Sartori, Brian A. Baker, Catalin Toma, Stuart Keller, Usman Baber, Timothy D. Henry, Mark B. Effron, George Dangas, Stuart J. Pocock, Roxana Mehran, Samir R. Kapadia, Anthony C. DeFranco, Sunil V. Rao, Craig Strauss, Jaya Chandrasekhar, Annapoorna Kini, Birgit Vogel, Sandra Weiss, and Joseph B. Muhlestein
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medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,medicine.disease ,Clopidogrel ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Kidney disease ,medicine.drug - Abstract
Objectives This study sought to compare clinical outcomes in a contemporary acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) cohort stratified by chronic kidney disease (CKD) status. Background Patients with CKD exhibit high risks for both thrombotic and bleeding events, thus complicating decision making regarding antiplatelet therapy in the setting of ACS. Methods The PROMETHEUS study was a multicenter observational study comparing outcomes with prasugrel versus clopidogrel in ACS PCI patients. Major adverse cardiac events (MACE) at 90 days and at 1 year were defined as a composite of death, myocardial infarction, stroke, or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Cox regression multivariable analysis was performed for adjusted associations between CKD status and clinical outcomes. Hazard ratios for prasugrel versus clopidogrel treatment were generated using propensity score stratification. Results The total cohort included 19,832 patients, 28.3% with and 71.7% without CKD. CKD patients were older with greater comorbidities including diabetes and multivessel disease. Prasugrel was less often prescribed to CKD versus non-CKD patients (11.0% vs. 24.0%, respectively; p Conclusions Although risks for 1-year MACE were significantly higher in ACS PCI patients with versus without CKD, prasugrel use was 50% lower in patients with renal impairment. Irrespective of CKD status, outcomes associated with prasugrel use were not significant after propensity adjustment. These data highlight the need for randomized studies evaluating the optimal antiplatelet therapy in CKD patients with ACS.
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- 2017
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12. Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study
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Mark B. Effron, William S. Weintraub, Catalin Toma, Elizabeth Marrett, J. Brent Muhlestein, Sunil V. Rao, Craig Strauss, Usman Baber, Sameer Bansilal, Samir R. Kapadia, Stuart J. Pocock, Roxana Mehran, Kanhaiya L. Poddar, Stuart Keller, Sandra Weiss, Annapoorna Kini, Jaya Chandrasekhar, Brian A. Baker, Melissa Aquino, Timothy D. Henry, Anthony C. DeFranco, and Samantha Sartori
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Male ,Acute coronary syndrome ,medicine.medical_specialty ,Ticlopidine ,Prasugrel ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Cause of Death ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,Aged ,Retrospective Studies ,Prasugrel Hydrochloride ,Dose-Response Relationship, Drug ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Clopidogrel ,Survival Rate ,Treatment Outcome ,Preoperative Period ,Conventional PCI ,Purinergic P2Y Receptor Antagonists ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,Follow-Up Studies ,medicine.drug - Abstract
BACKGROUND AND OBJECTIVES: We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice. METHODS: PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90days, a composite of all-cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Major bleeding was defined as any bleeding requiring hospitalization or blood transfusion. Hazard ratios (HRs) were generated using multivariable Cox regression and stratified by the propensity to treat with prasugrel. RESULTS: Of 19,914 patients (mean age 64.4years, 32% female), 4,058 received prasugrel (20%) and 15,856 received clopidogrel (80%). Prasugrel-treated patients were younger with fewer comorbid risk factors compared with their counterparts receiving clopidogrel. At 90days, there was a significant association between prasugrel use and lower major adverse cardiovascular event (5.7% vs 9.6%, HR 0.58, 95% CI 0.50-0.67, P
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- 2017
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13. Long-term use of dual antiplatelet therapy for the secondary prevention of atherothrombotic events: Meta-analysis of randomized controlled trials
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Sumaya Hammami, William S. Weintraub, Amratash Malodiya, Zaher Fanari, Sandra Weiss, and Paul Kolm
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medicine.medical_specialty ,Time Factors ,animal structures ,Prasugrel ,Myocardial Infarction ,Hemorrhage ,030204 cardiovascular system & hematology ,Lower risk ,Article ,Drug Administration Schedule ,law.invention ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Randomized controlled trial ,Recurrence ,Risk Factors ,law ,Internal medicine ,Odds Ratio ,Secondary Prevention ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Randomized Controlled Trials as Topic ,Aspirin ,business.industry ,Thrombosis ,General Medicine ,Clopidogrel ,medicine.disease ,Treatment Outcome ,Cardiology ,Platelet aggregation inhibitor ,Drug Therapy, Combination ,Cardiology and Cardiovascular Medicine ,business ,Ticagrelor ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Background The potential benefit of long-term dual antiplatelet therapy (DAPT) for secondary prevention of atherothrombotic events is unclear. Data from different randomized controlled trials (RCT) using different agents in different subgroups showed inconsistent results. Methods We performed a systematic review and meta-analysis from RCTs that tested different prolonged durations of DAPT for secondary prevention. Long term DAPT arm was defined as those receiving DAPT for more than 12 months. Long-term aspirin arm was defined as those receiving either aspirin alone long term or DAPT for less than 12 months. Results The use of long term DAPT was associated with a significant decrease in composite of death, myocardial infarction (MI) and stroke (6.08% vs. 6.71%; odds ratio OR = 0.86 [0.78–0.94]; P = 0.001). This reduction of death, MI and stroke was mainly noticed in patients with prior MI or stroke, but not with PAD or multiple risk factors. The reduction was seen with post PCI patients with prasugrel and only in those with prior MI with clopidogrel and ticagrelor. Long-term use of DAPT was associated with significant increase in major bleeding (1.47% vs. 0.88%; OR = 1.65 [1.23–2.21]; P = 0.001). Conclusion Long-term use of DAPT for secondary prevention is associated with lower risk of death, MI and stroke beneficial especially in patients with prior MI and stroke, but it is associated with increased risk of bleeding. Prolonging DAPT requires careful assessment of the trade-off between ischemic and bleeding complications and should probably be reserved for patients with higher risk for atherothrombotic events.
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- 2017
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14. Structural basis for the activation and inhibition of Sirtuin 6 by quercetin and its derivatives
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Weijie You, Wei Zheng, Sandra Weiss, Katrin F. Chua, and Clemens Steegborn
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Models, Molecular ,Natural products ,Binding Sites ,lcsh:R ,Small molecules ,lcsh:Medicine ,Acetylation ,Crystallography, X-Ray ,Ligands ,Biochemistry ,Chemical biology ,Article ,Enzymes ,Structure-Activity Relationship ,Humans ,Protein Isoforms ,Sirtuins ,lcsh:Q ,Quercetin ,lcsh:Science ,Structural biology - Abstract
Mammalian Sirtuin 6 (Sirt6) is an NAD+-dependent protein deacylase regulating metabolism and chromatin homeostasis. Sirt6 activation protects against metabolic and aging-related diseases, and Sirt6 inhibition is considered a cancer therapy. Available Sirt6 modulators show insufficient potency and specificity, and even partially contradictory Sirt6 effects were reported for the plant flavone quercetin. To understand Sirt6 modulation by quercetin-based compounds, we analysed their binding and activity effects on Sirt6 and other Sirtuin isoforms and solved crystal structures of compound complexes with Sirt6 and Sirt2. We find that quercetin activates Sirt6 via the isoform-specific binding site for pyrrolo[1,2-a]quinoxalines. Its inhibitory effect on other isoforms is based on an alternative binding site at the active site entrance. Based on these insights, we identified isoquercetin as a ligand that can discriminate both sites and thus activates Sirt6 with increased specificity. Furthermore, we find that quercetin derivatives that inhibit rather than activate Sirt6 exploit the same general Sirt6 binding site as the activators, identifying it as a versatile allosteric site for Sirt6 modulation. Our results thus provide a structural basis for Sirtuin effects of quercetin-related compounds and helpful insights for Sirt6-targeted drug development.
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- 2019
15. America's Healthcare Transformation
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Thomas H. Lee, Janet J. Teske, Victor M. Montori, Nana E. Coleman, Alberta T. Pedroja, Mauro Ferrari, Nikhil G. Thaker, Kasaiah Makam, Philip Greenland, Ju-Young Kim, Henry H. Ting, Sharyl Wojciechowski, Alicia D. Monroe, Deirde Mylod, Gary S. Kaplan, Elizabeth Malcolm, Kenneth Patric, Susan A. Abookire, Marc L. Boom, Kunal N. Karmali, Jason Gorevic, Hanh H. Hoang, Kasey R. Boehmer, Arthur \\'Tim\\' Garson, James L. Field, Amir Rubin, William S. Weintraub, Mark R. Chassin, Steven R. Steinhubl, Sarah P. Slight, Arnold Milstein, Erin DuPree, Julia D. Andrieni, David W. Bates, Tine Hansen-Turton, Sandra Weiss, and Thomas W. Feeley
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Economic growth ,business.industry ,Health care ,business ,Transformation (music) - Published
- 2019
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16. Prasugrel use and clinical outcomes by age among patients undergoing PCI for acute coronary syndrome: from the PROMETHEUS study
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Brian A. Baker, Kamilia Moalem, Catalin Toma, Bimmer E. Claessen, Zhen Ge, Jaya Chandrasekhar, Stuart J. Pocock, Mark B. Effron, Roxana Mehran, William S. Weintraub, Samir R. Kapadia, Joseph B. Muhlestein, Sunil V. Rao, Craig Strauss, Annapoorna Kini, Stuart Keller, Birgit Vogel, Sandra Weiss, Usman Baber, George Dangas, Melissa Aquino, Samantha Sartori, Timothy D. Henry, and Anthony C. DeFranco
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,Thienopyridine ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Coronary Angiography ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Internal medicine ,Preoperative Care ,Medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Acute Coronary Syndrome ,Aged ,business.industry ,Incidence ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,Clopidogrel ,medicine.disease ,United States ,Survival Rate ,Treatment Outcome ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Mace ,Platelet Aggregation Inhibitors ,medicine.drug ,Follow-Up Studies - Abstract
Prasugrel is a potent thienopyridine that may be preferentially used in younger patients with lower bleeding risk.We compared prasugrel use and outcomes by age from the PROMETHEUS study. We also assessed age-related trends in treatment effects with prasugrel versus clopidogrel.PROMETHEUS was a multicenter acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) registry. We compared patients in age tertiles (T1 60 years, T2 60-70 years, T3 70 years). Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke or unplanned revascularization. Data were adjusted using multivariable Cox regression for age-related risks and propensity score stratification for thienopyridine effects.The study included 19,914 patients: 7045 (35.0%) in T1, 6489 (33.0%) in T2 and 6380 (32.0%) in T3. Prasugrel use decreased from T1 to T3 (29.2% vs. 23.5% vs. 7.5%, p 0.001). Crude 1-year MACE rates were highest in T3 (17.4% vs. 16.8% vs. 22.7%, p 0.001), but adjusted risk was similar between the groups (p-trend 0.52). Conversely, crude incidence (2.8% vs. 3.8% vs. 6.9%, p 0.001) and adjusted bleeding risk were highest in T3 (HR 1.24, 95% CI 0.99-1.55 in T2; HR 1.83, 95% CI 1.46-2.30 in T3; p-trend 0.001; reference = T1). Treatment effects with prasugrel versus clopidogrel did not demonstrate age-related trends for MACE (p-trend = 0.91) or bleeding (p-trend = 0.28).Age is a strong determinant of clinical risk as well as prasugrel prescription in ACS PCI with much lower use among older patients. Prasugrel did not have a differential treatment effect by age for MACE or bleeding. Frequency of prasugrel use and age-related temporal risks of all-cause death and bleeding after ACS PCI.
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- 2019
17. Aerococcus Urinae: A rare cause for multi-valve endocarditis
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Jaya D. Bathina, Kasaiah Makam, Sandra Weiss, and Robin Horn
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medicine.medical_specialty ,biology ,business.industry ,biology.organism_classification ,medicine.disease ,Internal medicine ,Cardiology ,General Earth and Planetary Sciences ,Medicine ,Endocarditis ,Aerococcus urinae ,Transthoracic echocardiogram ,business ,General Environmental Science - Published
- 2019
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18. Qualitative and Quantitative Analysis of Different Rhodiola rosea Rhizome Extracts by UHPLC-DAD-ESI-MSn
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Sandra Weiss, Fabian Alperth, Ivana Turek, Franz Bucar, and Dietmar Vogt
- Subjects
cinnamyl alcohol glycosides ,Pharmaceutical Science ,lcsh:RS1-441 ,01 natural sciences ,ASE ,UHPLC-MS ,lcsh:Pharmacy and materia medica ,chemistry.chemical_compound ,Flavonols ,chemistry.chemical_classification ,Chromatography ,Cinnamyl alcohol ,biology ,010405 organic chemistry ,010401 analytical chemistry ,Salidroside ,Rosavin ,biology.organism_classification ,Rosarin ,flavonols ,salidroside ,0104 chemical sciences ,Rosiridin ,Rhodiola rosea ,chemistry ,Kaempferol - Abstract
Rhodiola rosea has been used in folk medicine as ethanolic macerates for a long time. This study aims to provide a quantitative and qualitative analysis and comparison of different ethanolic Rhodiola rosea rhizome macerates (35%, 70%, and 96% v/v) and accelerated solvent extraction (ASE) extracts prepared with 85% methanol, in order to shed light on the effectivity of different extraction methods. Extract samples were analyzed by UHPLC-DAD-ESI-MSn on a ZORBAX SB-C18 column (100 ×, 2.1 mm, 1.8 &mu, m) with a mobile phase consisting of water + 0.1% formic acid and acetonitrile. Qualitative analysis lead to the tentative identification of 18 compounds: Two cyanogenic glycosides (rhodiocyanoside A, lotaustralin), three phenylethanoids (salidroside, viridoside, 2-phenylethyl-vicianoside), two procyanidin and catechin derivatives (epigallocatechin-epigallocatechin gallate, epigallocatechin-3-O-gallate), five phenylpropanoids (cinnamyl alcohol, rosarin, rosavin, rosin, cinnamyl-(6&rsquo, O-&beta, d-xylopyranosyl)-O-&beta, glucopyranoside), two monoterpene alcohols (rhodioloside E, rosiridin) and four flavonols (rhodionidin, rhodiosin, rhodionin, kaempferol). Quantity was determined for salidroside, cinnamyl alcohol and its three major glycosides (rosarin, rosavin, rosin), as well as three flavonols (rhodionidin, rhodiosin, rhodionin). Methanolic ASE proved to be the superior extraction method for different substance groups. For macerates, high ethanol content increased yield and lowered hydrolysis of glycosides during extraction, but ethanolic macerates still showed low reproducibility and high fluctuations in quantity of marker compounds salidroside and rosavins, as well as flavonols. Rhodiola rosea rhizomes of wild origins seemed to underly great variability in chemical composition dependent on grow site.
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- 2019
19. Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study
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Jaya Chandrasekhar, Samir Kapadia, Brian A. Baker, Michela Faggioni, Sunil V. Rao, Craig Strauss, Anthony C. DeFranco, Timothy Henry, William S. Weintraub, Mark B. Effron, Annapoorna Kini, Samantha Sartori, Stuart Keller, Sandra Weiss, Stuart J. Pocock, Usman Baber, Melissa Aquino, Brent Muhlestein, Roxana Mehran, and Catalin Toma
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Acute coronary syndrome ,medicine.medical_specialty ,Prasugrel ,Prasugrel Hydrochloride ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Percutaneous coronary intervention ,Retrospective cohort study ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Clopidogrel ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Mace ,medicine.drug - Abstract
Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under-treatment. We sought to compare the 1-year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort. : PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression. : The study cohort included 4,851 patients of which 1,162 (24.0%) were women and 3,689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one-third of patients (31.8% in men vs. 28.1% in women, P = 0.01). Unadjusted, 1-year MACE (21.1% vs. 16.2%, P : Women ≤ 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1-year MACE and bleeding than male sex, findings that are attributable to baseline differences. © 2016 Wiley Periodicals, Inc.
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- 2016
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20. BRASH SYNDROME: AN ENTITY BETWEEN HYPERKALEMIA AND ATRIOVENTRICULAR NODAL BLOCKADE TOXICITY
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Jesse Liou, Sandra Weiss, and Amar Kaneria
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Hyperkalemia ,business.industry ,Critical Care and Intensive Care Medicine ,Blockade ,Internal medicine ,Toxicity ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,NODAL ,business - Published
- 2020
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21. The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry
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George Dangas, Samantha Sartori, Shawn X. Li, Serdar Farhan, Timothy Henry, Mark B. Effron, Anthony C. DeFranco, Stuart Keller, Bimmer E. Claessen, Jaya Chandrasekhar, Samir Kapadia, Michela Faggioni, Brent Muhlestein, Zhen Ge, Stuart J. Pocock, Birgit Vogel, Sandra Weiss, Sunil V. Rao, Craig Strauss, Usman Baber, Brian A. Baker, Annapoorna Kini, Roxana Mehran, Sabato Sorrentino, and Catalin Toma
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Male ,medicine.medical_specialty ,Acute coronary syndrome ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,Comorbidity ,030204 cardiovascular system & hematology ,Lower risk ,Drug Prescriptions ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Registries ,Acute Coronary Syndrome ,Practice Patterns, Physicians' ,Stroke ,Aged ,business.industry ,Incidence ,Percutaneous coronary intervention ,Cardiovascular Agents ,General Medicine ,Middle Aged ,medicine.disease ,Drug Utilization ,Patient Discharge ,United States ,Treatment Outcome ,Conventional PCI ,Practice Guidelines as Topic ,Cardiology ,Polypharmacy ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Kidney disease - Abstract
Objectives: To investigate the prevalence, predictors and associations between guideline-directed medical therapy (GDMT) and clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) from eight academic centers in the United States. Background: Evidence for GDMT in patients with AMI comes from randomized controlled trials. The use of GDMT in clinical practice is unknown in this setting. Methods: PROMETHEUS is a multicenter observational registry comprising 19,914 patients with acute coronary syndrome (ACS) undergoing PCI. Patients with AMI were divided into two groups based on the prescription of GDMT or not (non-GDMT) at discharge. GDMT was defined according to American College of Cardiology/American Heart Association (ACC/AHA) class I recommendations, specifically, dual antiplatelet therapy, statin and beta-blocker for all AMI patients, and additional ACEI/ARB in patients with left ventricular ejection fraction (LVEF) less than 40%, hypertension, diabetes mellitus (DM) or chronic kidney disease (CKD). The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause death, MI, stroke or unplanned target vessel revascularization (TVR) at 1 year. Results: Out of 4,834 patients with AMI, 3,356 (69.4%) patients were discharged on GDMT. Patients receiving GDMT were more often younger and male. Compared with non-GDMT patients, GDMT patients had a significantly lower frequency of comorbidities. Predictors of greater GDMT prescription at discharge were ST-segment elevation myocardial infarction (STEMI), and increased body mass index (BMI), whereas hypertension, prior PCI, anemia and CKD were associated with less GDMT prescription. At 1 year, the use of GDMT was associated with a significantly lower incidence of MACE (13.7% vs. 22.5%; adjusted HR 0.68; 95%CI 0.58–0.80; P < 0.001), death (3.7% vs. 9.4%; adjusted HR 0.61; 95%CI 0.46–0.80; P < 0.001), and unplanned TVR (8.4% vs. 11.3%; adjusted HR 0.76; 95%CI 0.61–0.96; P = 0.020). However, there were no significant differences in the incidence of MI (4.3% vs. 7.0%; adjusted HR 0.75; 95%CI 0.56–1.01; P = 0.056), stroke (1.5% vs. 2.0%; adjusted HR 0.79; 95%CI 0.47–1.34; P = 0.384) between the two groups. Conclusion: In a contemporary practice setting in the United States, GDMT was utilized in just over two-thirds of AMI patients undergoing PCI. Predictors of GDMT prescription at discharge included STEMI, BMI and absence of hypertension, CKD, anemia or prior PCI. Use of GDMT was associated with significantly lower risk of 1-year MACE and mortality.
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- 2018
22. Medical economics and interventional cardiology
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Zaher Fanari, William S. Weintraub, and Sandra Weiss
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medicine.medical_specialty ,Interventional cardiology ,Medical economics ,business.industry ,medicine ,Medical physics ,business - Abstract
The field of interventional cardiology has undergone tremendous changes over the last 10 years, with advancement of the management pathways of both stable coronary artery disease and acute coronary syndrome and expansion in the volume of non-coronary interventions especially structural heart disease interventions. This chapter discusses the medical economics of interventional procedures in the current era.
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- 2018
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23. Percutaneous Coronary Intervention for Stable Ischemic Heart Disease
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Abdul Latif Bikak, William S. Weintraub, and Sandra Weiss
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medicine.medical_specialty ,Acute coronary syndrome ,Percutaneous ,business.industry ,medicine.medical_treatment ,Stent ,Percutaneous coronary intervention ,medicine.disease ,Revascularization ,Asymptomatic ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,Myocardial infarction ,medicine.symptom ,business ,Artery - Abstract
Coronary angiography and revascularization began in the 1960s and has evolved dramatically into a robust platform for not only diagnosis of coronary disease but also complex intervention. The phenomenal number of procedures, over a million by the mid-2000s in the United States alone, has helped improve operator expertise. This coupled with advances in equipment, specifically in stent technology, has made percutaneous intervention an increasingly preferred modality in various clinical scenarios. With this, the world saw ever-increasing revascularization of coronary stenoses in patients ranging from those with asymptomatic lesions to those suffering an acute myocardial infarction. However, even though coronary intervention through both percutaneous coronary intervention and coronary artery bypass grafting have greatly improved outcomes in the setting of acute coronary syndrome, the same has not been systematically true for stable ischemic heart disease.
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- 2018
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24. Endovascular Management of Middle Aortic Syndrome Presenting with Uncontrolled Hypertension
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Kathryn E. Bowser, Sandra Weiss, F Todd Harad, and Owen S Glotzer
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,Open surgery ,Abdominal aorta ,General Engineering ,Case Report ,Emergency department ,030204 cardiovascular system & hematology ,medicine.disease ,Middle aortic syndrome ,Surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,lcsh:RC666-701 ,medicine.artery ,Vascular Disorder ,medicine ,cardiovascular system ,Rare syndrome ,030212 general & internal medicine ,Arteritis ,business - Abstract
Middle Aortic Syndrome is a rare vascular disorder consisting of narrowing or stenosis of the distal thoracic or abdominal aorta. It is described in the literature in the form of case studies and case series. The authors present an unusual case of Middle Aortic Syndrome attributed to Takayasu’s arteritis in a 60-year-old female who presented to the emergency department with uncontrolled hypertension. Traditional intervention involves open surgical bypass. This case study reviews the published literature on this rare syndrome and illustrates a successful alternative to open surgery through an endovascular approach.
- Published
- 2018
25. Clinical Trials Versus Clinical Practice
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Pranav Kansara, Lloyd W. Klein, S. Tanveer Rab, Matthew C. Hann, William S. Weintraub, Sandra Weiss, and James E. Tcheng
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medicine.medical_specialty ,Cost effectiveness ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Evidence-based medicine ,Revascularization ,medicine.disease ,Appropriate Use Criteria ,Surgery ,law.invention ,Clinical trial ,Coronary artery disease ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
The planning of revascularization strategy for multivessel coronary artery disease (CAD) in nondiabetic patients is optimally made through considering the goals of improving survival and/or relieving symptoms. Existing clinical practice guidelines and appropriate use criteria [(1–3)][1] state
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- 2015
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26. Combining wrist age and third molars in forensic age estimation: how to calculate the joint age estimate and its error rate in age diagnostics*
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Angelika Stellzig-Eisenhauer, Eve Tausche, Götz Gelbrich, Carolin Frerking, Bianca Gelbrich, Sebastian Schwerdt, and Sandra Weiss
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Male ,Molar ,Aging ,Adolescent ,Physiology ,Epidemiology ,Radiography ,Word error rate ,Dentistry ,Wrist ,Standard deviation ,Correlation ,Young Adult ,Calcification, Physiologic ,Age Determination by Skeleton ,Germany ,Genetics ,medicine ,Humans ,Young adult ,Child ,Retrospective Studies ,Orthodontics ,business.industry ,Public Health, Environmental and Occupational Health ,Linear model ,medicine.anatomical_structure ,Linear Models ,Female ,Molar, Third ,Age Determination by Teeth ,business ,Tooth Calcification - Abstract
Forensic age estimation in living adolescents is based on several methods, e.g. the assessment of skeletal and dental maturation. Combination of several methods is mandatory, since age estimates from a single method are too imprecise due to biological variability. The correlation of the errors of the methods being combined must be known to calculate the precision of combined age estimates.To examine the correlation of the errors of the hand and the third molar method and to demonstrate how to calculate the combined age estimate.Clinical routine radiographs of the hand and dental panoramic images of 383 patients (aged 7.8-19.1 years, 56% female) were assessed.Lack of correlation (r = -0.024, 95% CI = -0.124 to + 0.076, p = 0.64) allows calculating the combined age estimate as the weighted average of the estimates from hand bones and third molars. Combination improved the standard deviations of errors (hand = 0.97, teeth = 1.35 years) to 0.79 years.Uncorrelated errors of the age estimates obtained from both methods allow straightforward determination of the common estimate and its variance. This is also possible when reference data for the hand and the third molar method are established independently from each other, using different samples.
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- 2015
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27. Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review
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Zaher Fanari, Sandra Weiss, and William S. Weintraub
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Acute coronary syndrome ,medicine.medical_specialty ,Prasugrel ,Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,Myocardial Infarction ,Myocardial Reperfusion Injury ,Platelet Glycoprotein GPIIb-IIIa Complex ,Article ,Fibrinolytic Agents ,Antithrombotic ,medicine ,Humans ,Bivalirudin ,Pharmacology (medical) ,cardiovascular diseases ,Acute Coronary Syndrome ,Intensive care medicine ,Aspirin ,business.industry ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Clopidogrel ,Purinergic P2Y Receptor Antagonists ,Drug Therapy, Combination ,Cardiology and Cardiovascular Medicine ,business ,Ticagrelor ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Acute coronary syndromes (ACS) are associated with high rates of morbidity and mortality. The advances of antiplatelet and anticoagulation therapy over several years time have resulted in improved in cardiac outcomes, but with increased health care costs. Multiple cost-effectiveness studies have been performed to evaluate the use of available antiplatelet agents and anticoagulation in the setting of both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Early on, the use of glycoprotein IIb/IIIa receptor inhibitors (GPIs) proved to be economically attractive in the management of ACS; however, the introduction of P2Y12 receptor antagonists limited their use to a bail out agents in complex interventions. Generic clopidogrel is probably still an economically attractive P2Y12 receptor antagonist choice, especially in low-risk ACS, while both ticagrelor and prasugrel present an economically attractive alternative option, especially in high-risk ACS and patients at risk for stent thrombosis. While enoxaparin presents an economically dominant alternative to heparin in NSTE-ACS, its role in STEMI in the contemporary era is unclear. During percutaneous coronary intervention (PCI), bivalirudin monotherapy was shown to be an economically dominant alternative to the combination of heparin and GPI in ACS. However, new studies may suggest that using heparin monotherapy may offer an attractive alternative. The comparative and cost effectiveness of different combinations of antiplatelet and antithrombotic therapy will be the focus of future expected clinical and economic assessments.
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- 2015
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28. Comparison of percutaneous coronary intervention with drug eluting stents versus coronary artery bypass grafting in patients with multivessel coronary artery disease: Meta-analysis of six randomized controlled trials
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Zaher Fanari, William S. Weintraub, Wei Zhang, Seema S. Sonnad, and Sandra Weiss
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Coronary Angiography ,Risk Assessment ,Severity of Illness Index ,Article ,law.invention ,Coronary Restenosis ,Coronary artery disease ,Percutaneous Coronary Intervention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Angioplasty, Balloon, Coronary ,Coronary Artery Bypass ,Survival rate ,Stroke ,Randomized Controlled Trials as Topic ,business.industry ,Patient Selection ,Incidence (epidemiology) ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,medicine.disease ,Survival Rate ,Treatment Outcome ,surgical procedures, operative ,Drug-eluting stent ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
article i nfo Percutaneous coronary intervention Coronary artery bypass grafting Drug eluting stents Randomized control trials Objective: To compare outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT). Background: PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCTs have compared outcomes of the two modalities in patients with multivessel CAD. Methods: We did a meta-analysis from six RCTs in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively. Results: Compared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR = 2.31; 95% CI: (1.80-2.96); P = b0.0001), lower incidence of stroke (RR = 0.35; 95% CI: (0.19-0.62); P = 0.0003), and no difference in death (RR = 1.02; 95% CI: (0.77-1.36); P = 0.88) or MI (RR = 1.16; 95% CI: (0.72-1.88); P = 0.53). At 5 years, PCI was associated with a higher incidence of death (RR = 1.3; 95% CI: (1.10-1.54); P = 0.0026) and MI (RR = 2.21; 95% CI: (1.75-2.79); P = b0.0001). While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients. Conclusion:Inpatientswithmulti-vesselCAD,PCIwithDESisassociatedwithnosignificantdifferenceindeathor MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI.
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- 2015
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29. Meta-analysis of three randomized controlled trials comparing coronary artery bypass grafting with percutaneous coronary intervention using drug-eluting stenting in patients with diabetes
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William S. Weintraub, Seema S. Sonnad, Wei Zhang, Zaher Fanari, and Sandra Weiss
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,Coronary Artery Disease ,Prosthesis Design ,Revascularization ,Risk Assessment ,law.invention ,Coronary artery bypass surgery ,Percutaneous Coronary Intervention ,Randomized controlled trial ,Risk Factors ,law ,Internal medicine ,Odds Ratio ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Coronary Artery Bypass ,Stroke ,Randomized Controlled Trials as Topic ,business.industry ,Incidence ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,medicine.disease ,Treatment Outcome ,surgical procedures, operative ,Conventional PCI ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Diabetic Angiopathies - Abstract
Objectives Coronary artery bypass grafting (CABG) was found to be the preferred strategy of revascularization in patients with diabetes in the bare-metal stent (BMS) era. The introduction of drug-eluting stents (DESs) led to a significant reduction in the rates of repeat revascularization (RRV) when compared with BMSs. We did a collaborative analysis of data from randomized controlled trials in the contemporary era to compare CABG versus percutaneous coronary intervention using DESs in diabetic patients. Methods We performed a systematic review and meta-analysis from randomized trials in the contemporary era comparing PCI with DESs with CABG in diabetic patients with multivessel disease. A comprehensive literature search (1 January 2003 to 18 May 2013) identified randomized controlled trials that reported long-term outcomes comparing PCI using DESs with CABG in 2974 diabetic patients. Results At 1 year, PCI was associated with a significant increase in the incidence of RRV [2.48 (1.56-3.94); P ≤0.0001], lower incidence of stroke [relative risk (RR) = 0.43 (0.19-0.81); P = 0.017], and no difference in death or myocardial infarction (MI). At 5 years, PCI was still associated with a lower incidence of stroke, but was associated with a significant increase in the incidence of death [RR = 1.36 (1.11-1.66); P = 0.0033] and MI [RR = 2.01 (1.54-2.62); P ≤0.0001]. Conclusions In patients with diabetes, PCI was associated with no difference in death and MI at 1 year. However, at 5 years, PCI was associated with a higher incidence of death and MI. PCI was associated with a higher incidence of RRV but a lower incidence of stroke.
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- 2014
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30. Cost–effectiveness assessment of cardiac interventions: determining a socially acceptable cost threshold
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William S. Weintraub, Sandra Weiss, Chete Eze-Nliam, and Zugui Zhang
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Relative value ,business.industry ,Cost effectiveness ,Psychological intervention ,Bioinformatics ,Article ,Health services ,Intervention (law) ,Risk analysis (engineering) ,Cardiac interventions ,Health care ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Health care is a vital good for which there is an infinite demand. However, societal resources are finite and need to be distributed efficiently to avoid waste. Thus, the relative value of an intervention - cost compared to its effectiveness- needs to be taken into consideration when deciding which interventions to adopt. Cost-effectiveness analysis provides the crucial information which guides these decisions. As the field of medicine and indeed cardiology move forward with innovations which are effective but often expensive, it becomes imperative to employ these cost-effectiveness analytic tools, not with the intention of denying vital health services but to ascertain what the society willing to pay for.
- Published
- 2014
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31. Coronary Revascularization in the Current Era
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Sandra Weiss and William S. Weintraub
- Subjects
medicine.medical_specialty ,Myocardial revascularization ,business.industry ,Treatment outcome ,Myocardial Infarction ,Anticoagulants ,Coronary Artery Disease ,medicine.disease ,Coronary revascularization ,Coronary artery disease ,Treatment Outcome ,Internal medicine ,Myocardial Revascularization ,medicine ,Cardiology ,Humans ,Platelet aggregation inhibitor ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Published
- 2015
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32. Academic Versus Private Cardiology
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Sandra Weiss and Zaher Fanari
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Gerontology ,Private practice ,business.industry ,MEDLINE ,Medicine ,Cardiovascular care ,Disease ,Cardiology and Cardiovascular Medicine ,business ,Career choice ,Cause of death - Abstract
Cardiovascular diseases are still considered the leading cause of death in the United States [(1)][1]. It is estimated that 40% of Americans will experience some form of cardiovascular disease by 2030 [(2)][2]. The advances in cardiovascular care required to meet this increased demand depend on the
- Published
- 2015
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33. Pipette aspiration applied to the characterization of nonhomogeneous, transversely isotropic materials used for vocal fold modeling
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Scott L. Thomson, Michael Döllinger, Alexander Sutor, Reinhard Lerch, and Sandra Weiß
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Male ,Materials science ,Acoustics ,Finite Element Analysis ,Biomedical Engineering ,Vocal Cords ,Suction ,Article ,Biomaterials ,Biomimetics ,Transverse isotropy ,Materials Testing ,otorhinolaryngologic diseases ,medicine ,Humans ,Anisotropy ,Mechanical Phenomena ,Pipette ,Fold (geology) ,Biomechanical Phenomena ,Vibration ,medicine.anatomical_structure ,Mechanics of Materials ,Homogeneous ,Vocal folds ,Collagen ,Stress, Mechanical ,Material properties - Abstract
The etiology and treatment of voice disorders are still not completely understood. Since the vibratory characteristics of vocal folds are strongly influenced by both anatomy and mechanical material properties, measurement methods to analyze the material behavior of vocal fold tissue are required. Due to the limited life time of real tissue in the laboratory, synthetic models are often used to study vocal fold vibrations. In this paper we focus on two topics related to synthetic and real vocal fold materials. First, because certain tissues within the human vocal folds are transversely isotropic, a fabrication process for introducing this characteristic in commonly used vocal fold modeling materials is presented. Second, the pipette aspiration technique is applied to the characterization of these materials. By measuring the displacement profiles of stretched specimens that exhibit varying degrees of transverse isotropy, it is shown that local anisotropy can be quantified using a parameter describing the deviation from an axisymmetric profile. The potential for this technique to characterize homogeneous, anisotropic materials, including soft biological tissues such as those found in the human vocal folds, is supplemented by a computational study.
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- 2013
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34. Sex-related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS study
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Jaya, Chandrasekhar, Usman, Baber, Samantha, Sartori, Michela, Faggioni, Melissa, Aquino, Annapoorna, Kini, William, Weintraub, Sunil, Rao, Samir, Kapadia, Sandra, Weiss, Craig, Strauss, Catalin, Toma, Brent, Muhlestein, Anthony, DeFranco, Mark, Effron, Stuart, Keller, Brian, Baker, Stuart, Pocock, Timothy, Henry, and Roxana, Mehran
- Subjects
Male ,Ticlopidine ,Incidence ,Age Factors ,Middle Aged ,Prognosis ,Risk Assessment ,United States ,Clopidogrel ,Survival Rate ,Percutaneous Coronary Intervention ,Postoperative Complications ,Sex Factors ,Treatment Outcome ,Humans ,Drug Therapy, Combination ,Female ,Acute Coronary Syndrome ,Sex Distribution ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,Follow-Up Studies ,Retrospective Studies - Abstract
Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under-treatment. We sought to compare the 1-year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort.PROMETHEUS was a retrospective multicenter observational US study comparing outcomes in clopidogrel and prasugrel treated patients following ACS PCI. MACE was defined as a composite of death, myocardial infarction, stroke or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Hazard ratios were generated using multivariable Cox proportional hazards regression.The study cohort included 4,851 patients of which 1,162 (24.0%) were women and 3,689 (76.0%) were men. In this cohort, the prevalence of diabetes (41.0 vs. 27.9%) and chronic kidney disease (12.7 vs. 7.2%) was higher among women compared with men. Irrespective of sex, prasugrel was used in less than one-third of patients (31.8% in men vs. 28.1% in women, P = 0.01). Unadjusted, 1-year MACE (21.1% vs. 16.2%, P 0.001) and bleeding (3.6% vs. 2.2%, P = 0.01) was significantly higher in women compared with men, but these results were no longer significant after adjustment for risk (HR 1.13, 95% CI 0.94-1.36 for MACE and HR 1.31, 95% CI 0.85-2.04 for bleeding).Women ≤ 55 years of age undergoing ACS PCI have significantly greater comorbidities than young men. Despite a higher risk clinical phenotype in women, prasugrel use was significantly lower in women than men. Female sex was associated with a significantly higher risk of 1-year MACE and bleeding than male sex, findings that are attributable to baseline differences. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
35. Overview of platelet functional testing methods and their controversial role in the clopidogrel-treated patient
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William S. Weintraub and Sandra Weiss
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medicine.medical_specialty ,Aspirin ,Percutaneous ,business.industry ,Functional testing ,Psychological intervention ,Clopidogrel ,Surgery ,P2Y12 ,Hemostasis ,medicine ,Platelet ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,medicine.drug - Abstract
Platelet functional testing has been available to clinicians for several decades. Despite certain limitations, it has proven useful in several arenas, including diagnosing bleeding disorders, assessment of platelet-derived hemostasis and for monitoring response to antiplatelet medication. Special attention has recently been paid to high residual platelet reactivity in patients undergoing percutaneous coronary interventions and being treated with antiplatelet medications, largely because of the increased risk of major cardiovascular events and stent thrombosis. In keeping with this, determining high residual platelet reactivity in patient appropriately taking aspirin and P2Y12 inhibitor therapy has focused attention on tests aimed at diagnosing poor antiplatelet, and specifically clopidogrel response. Based on this, attempts to predict and intervene on poor response and its potential outcomes are prominent in the current literature, with the assistance of both platelet functional analysis and genetic deter...
- Published
- 2012
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36. Application of the ADVIA cerebrospinal fluid assay to count residual red blood cells in blood components
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Katherine Serrano, Dana V. Devine, Sandra Weiss, Eric A. Stone, Elena Levin, and Brankica Culibrk
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Chromatography ,business.industry ,Potential risk ,Hematology ,General Medicine ,Gold standard (test) ,Residual ,Cerebrospinal fluid ,Apheresis ,Count rbcs ,Immunology ,Medicine ,Platelet ,Platelet concentrate ,business - Abstract
Background and Objectives There is no automated, accurate assay for the enumeration of residual red blood cells (rRBCs) in non-RBC components for transfusion, despite the potential risk of allo-immunization when mismatched components are transfused. Materials and Methods The automated ADVIA 120 cerebrospinal fluid (CSF) assay, which is approved to count RBCs and WBCs in CSF samples, was optimized and tested to measure rRBC in platelet concentrate (PC) and plasma components. Results Sample dilution, incubation time and reagent volume were optimized for use with non-RBC blood products. The assay was linear (R2 = 0·99), even at low rRBCs counts. Intra- and inter-assay variation gave coefficients of variance (CV) between 2·2 and 9·4% and 2·6 and 14·9%, respectively, depending on rRBC levels. Good correlation (r = 0·995) was found between the automated assay and manual counting, which is considered the gold standard. Using the automated assay, the range of rRBCs (count/unit) in buffy-coat platelet concentrate (PCs) was 27–5505 × 106 and in apheresis PCs was 1–361 × 106. Conclusion The ADVIA CSF assay is a sensitive, precise and accurate means to assess rRBC counts in non-RBC components.
- Published
- 2012
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37. In vitro platelet quality in storage containers used for pediatric transfusions
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Brankica Culibrk, Sandra Weiss, Kenneth Scammell, Sima Zolfaghari, Jason P. Acker, Maria I.C. Gyongyossy-Issa, and Elena Levin
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medicine.medical_specialty ,Platelet transfusion ,Apheresis ,business.industry ,Immunology ,Blood preservation ,Immunology and Allergy ,Medicine ,Platelet ,Hematology ,Food science ,business ,Surgery - Abstract
BACKGROUND: The in vitro quality of small-volume platelet (PLT) aliquots for pediatric transfusions was assessed to determine the best practice approach. STUDY DESIGN AND METHODS: Small volumes (50 mL) of single apheresis PLT components (APCs), collected on either CaridianBCT Trima or Haemonetics MCS+ instruments, were aliquoted on Days 2, 3, 4, and 5 postcollection into Fenwal PL1240 or 4R2014 bags or 60-mL polypropylene syringes. Samples were tested for in vitro quality at their recommended expiry times (4 hr for 4R2014 bags and syringes or Day 5 for PL1240 bags). Assays included pH, CD62P expression, and metabolic measures. RESULTS: CD62P expression increased throughout storage in all containers. Among the small-volume containers, pH, pCO2, lactate, and bicarbonate varied considerably. Regardless of the day of aliquoting, pCO2 was significantly higher and pO2 was significantly lower in gas-impermeable syringes than other containers. No bacterial growth was detected in any sample. CONCLUSION: The quality of APCs aliquoted into small-volume containers meets regulatory requirements and is generally equivalent to that of full-volume APCs at expiry.
- Published
- 2012
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38. TCT-747 Associations between Stent Diameter and Clinical Outcomes in ACS PCI Using Second Generation Drug-Eluting Stents: From the PROMETHEUS Study
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Roxana Mehran, Serdar Farhan, Madhav Sharma, Joseph B. Muhlestein, Annapoorna Kini, Sunil V. Rao, Craig Strauss, William S. Weintraub, Stuart Keller, Samantha Sartori, Zhen Ge, Stuart J. Pocock, Brian A. Baker, Sandra Weiss, Catalin Toma, Usman Baber, Samir R. Kapadia, Mark B. Effron, Timothy D. Henry, Anthony C. DeFranco, Jaya Chandrasekhar, and Abdul Qadeer
- Subjects
Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine.medical_treatment ,Conventional PCI ,medicine ,Stent ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,media_common ,Surgery - Published
- 2017
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39. Magnetically resettable 0.16% free strain in polycrystalline Ni–Mn–Ga plates
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Sandra Weiss, Ludwig Schultz, Claudia Hürrich, Uwe Gaitzsch, Stefan Roth, Martin Pötschke, and Daoyong Cong
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Materials science ,Strain (chemistry) ,Mechanical Engineering ,Alloy ,Metals and Alloys ,engineering.material ,equipment and supplies ,Condensed Matter Physics ,Microstructure ,Magnetic field ,Crystallography ,Mechanics of Materials ,engineering ,General Materials Science ,Crystallite ,Texture (crystalline) ,Composite material ,Crystal twinning ,human activities ,Directional solidification - Abstract
We investigated the microstructure, mechanical training and free strain due to magnetically induced reorientation (MIR) of a polycrystalline Ni 50 Mn 29 Ga 21 alloy prepared by directional solidification, which showed columnar grains with a strong A fibre texture. Two-side mechanical training greatly decreased the twinning stress level of the properly cut plates. Consequently, a free strain of 0.16% has been observed in the trained plates and this strain is magnetically resettable more than 20 times by rotating the magnetic field by 90°.
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- 2010
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40. Plasma and cryoprecipitate manufactured from whole blood held overnight at room temperature meet quality standards
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Sandra Weiss, Maria I.C. Gyongyossy-Issa, Elena Levin, Brankica Culibrk, Ken Scammell, Dana V. Devine, and Katherine Serrano
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Blood Platelets ,medicine.medical_specialty ,Time Factors ,Cell Survival ,Immunology ,Centrifugation ,Buffy coat ,Fibrinogen ,Antithrombins ,Plasma ,medicine ,Humans ,Immunology and Allergy ,Whole blood ,Cryopreservation ,Factor VIII ,Chromatography ,British Columbia ,Platelet-Rich Plasma ,Protein Stability ,Chemistry ,Antithrombin ,Temperature ,Hematology ,Blood Coagulation Factors ,Surgery ,Cytapheresis ,Cryosupernatant ,Coagulation ,Blood Preservation ,Cryoprecipitate ,Platelet-rich plasma ,Blood Component Removal ,Blood Banks ,Leukocyte Reduction Procedures ,Filtration ,medicine.drug - Abstract
BACKGROUND: With buffy coat (BC) processing of whole blood (WB) donations, the preparation of plasma occurs within 24 hours rather than 8 hours of collection. The effect of this change on coagulation factor function in plasma and cryoprecipitate was evaluated during the validation of this production method and with routine production. STUDY DESIGN AND METHODS: Plasma frozen after an overnight hold of WB was prepared via BC or whole blood filtration (WBF) methods and quality control (QC) variables were measured. Additionally, plasma prepared with the BC method was compared to plasma produced using the platelet-rich plasma (PRP) method with an extended plasma factor analysis. Selected plasma factor levels were also measured in both cryoprecipitate and cryosupernatant plasma prepared using the WBF method from plasma frozen on the day of collection or after an overnight hold of WB. RESULTS: When comparing BC plasma to PRP plasma, coagulation factors (F)II, VII, VIII, IX, X, and XI had somewhat lower levels, and fibrinogen and antithrombin levels were elevated. As expected the most sensitive to the prolongation of production time was FVIII with 72 and 78% of the activity of PRP plasma and cryoprecipitate, respectively. However, both still met QC standards. Similarly, products made in routine production show acceptable levels of FVIII. CONCLUSION: Plasma and cryoprecipitate products, prepared using methods in which the plasma is frozen close to 24 hours after collection, meet current quality standards. The longer WB storage time has been implemented into general use in Canada.
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- 2010
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41. Performance characteristics of a novel blood bag in-line closure device and subsequent product quality assessment
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Sandra Weiss, Brankica Culibrk, Ken Scammell, Dana V. Devine, Katherine Serrano, Wolfgang F. Boecker, and Elena Levin
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Blood Platelets ,medicine.medical_specialty ,Erythrocytes ,Quality assessment ,Coefficient of variation ,Immunology ,Blood Component Removal ,Hematology ,Buffy coat ,medicine.disease ,Hemolysis ,Surgery ,Closure (computer programming) ,Repetitive strain ,Digital image analysis ,medicine ,Immunology and Allergy ,Humans ,Blood Donors and Blood Collection ,Biomedical engineering ,Mathematics - Abstract
BACKGROUND: In high-volume processing environments, manual breakage of in-line closures can result in repetitive strain injury (RSI). Furthermore, these closures may be incorrectly opened causing shear-induced hemolysis. To overcome the variability of in-line closure use and minimize RSI, Fresenius Kabi developed a new in-line closure, the CompoFlow, with mechanical openers. STUDY DESIGN AND METHODS: The consistency of the performance of the CompoFlow closure device was assessed, as was its effect on component quality. A total of 188 RBC units using CompoFlow blood bag systems and 43 using the standard bag systems were produced using the buffy coat manufacturing method. Twenty-six CompoFlow platelet (PLT) concentrates and 10 control concentrates were prepared from pools of four buffy coats. RBCs were assessed on Days 1, 21, and 42 for cellular variables and hemolysis. PLTs were assessed on Days 1, 3, and 7 for morphology, CD62P expression, glucose, lactate, and pH. A total of 308 closures were excised after processing and the apertures were measured using digital image analysis. RESULTS: The use of the CompoFlow device significantly improved the mean extraction time with 0.46 ± 0.11 sec/mL for the CompoFlow units and 0.52 ± 0.13 sec/mL for the control units. The CompoFlow closures showed a highly reproducible aperture after opening (coefficient of variation, 15%) and the device always remained opened. PLT and RBC products showed acceptable storage variables with no differences between CompoFlow and control. CONCLUSIONS: The CompoFlow closure devices improved the level of process control and processing time of blood component production with no negative effects on product quality.
- Published
- 2010
42. Novel system for storage of buffy-coat-derived platelet concentrates in a glucose-based platelet additive solution: parameters and metabolism during storage and comparison to plasma
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Elena Levin, Sandra Weiss, S. Holme, K. Scammell, D. L. Holmes, F. Hunter, Jerry G. Zhang, Maria I.C. Gyongyossy-Issa, and Brankica Culibrk
- Subjects
Blood Platelets ,Chromatography ,Chemistry ,Blood preservation ,Hematology ,General Medicine ,Metabolism ,Buffy coat ,Hydrogen-Ion Concentration ,Platelet storage ,Carbohydrate metabolism ,Platelet Activation ,Europe ,Pharmaceutical Solutions ,Plasma ,Glucose ,Autologous plasma ,Biochemistry ,Blood Preservation ,Humans ,Platelet ,Platelet activation ,Leukocyte Reduction Procedures - Abstract
Background In Europe, buffy-coat processing allows for the use of platelet additive solutions (PAS). These solutions, however, have long been questioned for their lack of glucose, a potentially essential nutrient for platelet storage. Using a novel, practical, two-part system for incorporation of glucose into an additive solution (PAS-G), this study compares platelet storage in plasma to storage in PAS-G. Study Design and Methods A paired study design of platelet concentrates (PC) were prepared from leucoreduced pools of eight buffy coats (BCP) split into two equal pools, with suspension in autologous plasma, or PAS-G. On days 2, 5, 7 and 9 of storage, samples were tested using standard in vitro platelet parameters. Data were analysed by paired Student's t-tests. Results During storage, PCs in PAS-G maintain a quality profile that is strikingly similar to PCs stored in plasma in terms of platelet activation (CD62) morphology score, swirl, glucose metabolism and pH. However, PCs in PAS-G perform lower (P
- Published
- 2009
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43. Implementation of buffy coat platelet component production: comparison to platelet-rich plasma platelet production
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Brankica Culibrk, Elena Levin, Craig Jenkins, Kenneth Scammell, Sandra Weiss, Maria I.C. Gyongyossy-Issa, Wanda Lefresne, and Dana V. Devine
- Subjects
Blood Platelets ,Immunology ,Centrifugation ,Cell Separation ,Buffy coat ,Andrology ,Leukocyte Count ,White blood cell ,Platelet production ,medicine ,Humans ,Immunology and Allergy ,Platelet ,Whole blood ,Blood Specimen Collection ,Platelet Count ,Platelet-Rich Plasma ,business.industry ,Hematology ,Hydrogen-Ion Concentration ,medicine.anatomical_structure ,Leukoreduction ,Blood Preservation ,Platelet-rich plasma ,Leukocyte Reduction Procedures ,Energy Metabolism ,business - Abstract
BACKGROUND: Buffy coat (BC) production of platelets (PLTs) has been successfully used in Europe for more than two decades. Currently, Canadian Blood Services is implementing the BC method. This article summarizes results of the validation testing performed to qualify the process of PLT production from whole blood and compares the quality of PLTs produced in routine production by either the PLT-rich plasma method (PRPPCs) or the BC method (BC-PCs). STUDY DESIGN AND METHODS: Validation data included variables used for routine quality control (QC; pH, PLT count, volume, sterility, residual white blood cell count) as well as nonroutine testing of PLTs for PLT activation, metabolic changes during storage, and PLT responsiveness to hypotonic shock and the extent of shape change induced by adenosine 5′-diphosphate. BC-PCs were tested on Days 1 and 6. QC of production runs included the same routine tests performed on Day 6. RESULTS: PLTs produced by the BC method during validation and pilot implementation met all Canadian Standards Association standards with respect to yield, volume, pH, and leukoreduction. Additional validation testing indicated a moderate level of PLT storage lesion development. In comparison to PRP-PCs, in vitro variables of BC-PCs, either pH in this study, or other markers compared to the literature were better, suggesting that BC-PCs have less evidence of productionrelated damage and improved PLT quality during storage. CONCLUSIONS: PLT concentrates produced from whole blood by the BC method after an overnight hold have laboratory variables suggestive of a higher quality than those concentrates produced by the PRP method. C anadian Blood Services undertook to change its method of component production from whole blood from the North American standard platelet-rich plasma (PRP) method to the buffy coat (BC) method of platelet (PLT) production. Developed by investigators in the Netherlands and Sweden in the mid-1970s, 1 the BC production method reverses the sequence of centrifugation steps compared to PRP. A hard spin is used initially to separate whole blood into three components: plasma, red blood cells (RBCs), and a BC layer. Using semiautomated extraction, the most common configuration uses a so-called top-and-bottom collection set in which plasma and RBCs are transferred to storage containers and the BC is left in the donation bag. This BC contains PLTs, white blood cells (WBCs), plasma, and some RBCs. ABO-matched BCs are pooled together with 1 plasma unit from one of the donors or 1 unit of PLT additive solution using a sterile docking device. The pooled BC is then given a soft spin, and the PRP is extracted with or without leukofiltration to produce a pooled PLT concentrate. Although both methods produce a PLT product, the products may have somewhat different in vitro characteristics. There is noticeable quality improvement in laboratory markers of BC-produced PLTs
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- 2008
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44. Comparison of a novel viscous platelet additive solution and plasma: preparation and in vitro storage parameters of buffy-coat-derived platelet concentrates
- Author
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Jerry G. Zhang, Kenneth Scammell, Maria I.C. Gyongyossy-Issa, Cedric J. Carter, Dana V. Devine, and Sandra Weiss
- Subjects
Chromatography ,Platelet-Rich Plasma ,Viscosity ,Plasma Substitutes ,Platelet Transfusion ,Hematology ,General Medicine ,Buffy coat ,Partial pressure ,Hydroxyethyl starch ,Plasma ,chemistry.chemical_compound ,Hypotonic Shock ,chemistry ,Biochemistry ,Carbon dioxide ,Osmoregulation ,medicine ,Blood Banks ,Humans ,Platelet ,Leukocyte Reduction Procedures ,Mean platelet volume ,medicine.drug - Abstract
Background and Objectives We developed a viscous platelet additive solution (PAS) based on MacoPharma's SSP+ but containing hydroxyethyl starch to address the poor osmotic balance and low yield associated with conventional PAS for the storage of buffy-coat platelet concentrates (PC). Materials and Methods Pools of four buffy-coats were made into leucoreduced PCs (n = 5) suspended either in plasma or viscous PAS. After determination of platelet recoveries, the PCs were stored under standard conditions. On days 1, 2, 3, 5, 7 and 9, PCs were tested for mean platelet volume, platelet concentration, soluble protein concentration, CD62 expression, platelet morphology, partial pressure of oxygen and partial pressure of carbon dioxide, glucose and lactate concentration, pH, extent of shape change, and hypotonic shock response (HSR). Results Platelets were prepared with greater ease using the viscous PAS and had improved platelet yield. PCs stored in either plasma or viscous PAS displayed similar storage characteristics to day 9. On days 7 and 9 of storage, platelets stored in viscous PAS displayed significantly lower (P
- Published
- 2008
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45. TCT-220 Effect of prasugrel versus clopidogrel in ACS patients with high or low BMI undergoing PCI: Results from the PROMETHEUS Study
- Author
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Usman Baber, Brian A. Baker, William S. Weintraub, Stuart Keller, Annapoorna Kini, Kanhaiya L. Poddar, Jennifer Chao, Samir R. Kapadia, Mark B. Effron, Roxana Mehran, Sunil V. Rao, Craig Strauss, Sandra Weiss, Timothy D. Henry, Melissa Aquino, Anthony C. DeFranco, Samantha Sartori, Jaya Chandrasekhar, and Joseph B. Muhlestein
- Subjects
medicine.medical_specialty ,Prasugrel ,business.industry ,Internal medicine ,Conventional PCI ,medicine ,Cardiology ,cardiovascular diseases ,business ,Clopidogrel ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Surgery - Published
- 2015
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46. Revascularization vs. Medical Therapy in Stable Ischemic Heart Disease
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Sandra Weiss and William S. Weintraub
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Myocardial Ischemia ,Fractional flow reserve ,Revascularization ,Risk Assessment ,Disease-Free Survival ,Article ,Coronary artery disease ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Coronary Artery Bypass ,business.industry ,Patient Selection ,Percutaneous coronary intervention ,Cardiovascular Agents ,Canadian Cardiovascular Society ,medicine.disease ,Treatment Outcome ,Drug-eluting stent ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The keynote COURAGE and BARI-2D trials changed the way the interventional community selects patients for revascularization. What we now consider appropriate, especially for percutaneous coronary intervention, has narrowed significantly in scope compared to previous practice a decade ago. Medical therapy has been shown to be both safe and effective as a primary treatment modality for patients with stable ischemic heart disease on the whole. However, it appears that patients with a heavy ischemic burden may benefit from revascularization, although investigation of this is ongoing. Evidence preliminarily supports this practice with coronary artery bypass grafting, and possibly in specific populations undergoing multivessel intervention with functional assessment of lesion severity during PCI.
- Published
- 2015
47. Clinical Trials Versus Clinical Practice: When Evidence and Practice Diverge--Should Nondiabetic Patients With 3-Vessel Disease and Stable Ischemic Heart Disease Be Preferentially Treated With CABG?
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Pranav, Kansara, Sandra, Weiss, William S, Weintraub, Matthew C, Hann, James, Tcheng, S Tanveer, Rab, and Lloyd W, Klein
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Clinical Trials as Topic ,Evidence-Based Medicine ,Patient Selection ,Cardiology ,Coronary Stenosis ,Coronary Artery Disease ,Risk Assessment ,Article ,Percutaneous Coronary Intervention ,Treatment Outcome ,Risk Factors ,Practice Guidelines as Topic ,Humans ,Stents ,Registries ,Coronary Artery Bypass ,Practice Patterns, Physicians' - Published
- 2015
48. Value of Primordial and Primary Prevention for Cardiovascular Diseases: A Global Perspective
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Sandra Weiss, William S. Weintraub, and Armin Barekatain
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education.field_of_study ,Tuberculosis ,business.industry ,Population ,Disease ,medicine.disease ,Primary prevention ,Environmental health ,medicine ,Economic impact analysis ,education ,business ,Developed country ,Malaria ,Cause of death - Abstract
Worldwide, cardiovascular disease (CVD) is estimated to be the leading cause of death and loss of disability-adjusted life years. Although age-adjusted cardiovascular death rates have declined in several developed countries in past decades, rates of cardiovascular disease have risen greatly in low-income and middle-income countries [1]. CVD is now the leading cause of death in all developing regions, with the exception of sub-Saharan Africa [1]. It causes twice as many deaths as HIV, malaria, and tuberculosis combined. Furthermore, due to the increasing prevalence of risk factors and lack of appropriate preventive measures, a relatively younger population is affected by CVD in these countries [2]. This leads to the loss of many potential years of productive life and places a huge economic burden on these countries. Hence, efforts to produce even modest reductions in age-specific disease rates could have a very large economic impact.
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- 2015
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49. Advanced and Expensive Cardiovascular Procedures in the Very Elderly–Can We or Should We Limit Access?
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Konstantinos Kossidas, Pranav Kansara, Sandra Weiss, and William S. Weintraub
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education.field_of_study ,Mitral valve repair ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MitraClip ,Population ,Cardiac resynchronization therapy ,Percutaneous coronary intervention ,medicine.disease ,Implantable cardioverter-defibrillator ,Sudden cardiac death ,Aortic valve replacement ,medicine ,Operations management ,business ,education ,Intensive care medicine - Abstract
With the increasing proportion of elderly patients in the population, physicians are often faced with challenging treatment decisions for the management of coronary artery diseases, valvular heart diseases, advanced heart failure and prevention of sudden cardiac death in the elderly patient population. Comprehensive review of the literature and available evidence is summarized in this chapter to guide such complex clinical decisions. Elderly patients presenting with an acute coronary syndrome (ACS) appear to benefit from percutaneous coronary intervention (PCI) with the use of drug eluting stents (DES). Though current guidelines do not consider age as a prohibitive factor, the risk of major bleeding complications and stroke should be carefully considered. For elderly patients with severe aortic stenosis, trans-catheter aortic valve replacement (TAVR) is superior compared to medical therapy for inoperable patients. TAVR, when performed via the transfemoral approach, remains non inferior and cost effective compared to surgical aortic valve replacement (SAVR). Trans-catheter mitral valve repair (TMVR) using MitraClip appears to be beneficial for inoperable patients with degenerative severe mitral regurgitation but more data are needed. Implantable cardioverter defibrillator (ICD) implantation in the elderly population remains a controversial topic especially for secondary prevention. The current evidence suggests that age should not be the sole withholding factor but the decision for ICD implantation should account for comorbidities and patient preference. On the other hand, cardiac resynchronization therapy (CRT) has definitely a mortality and morbidity benefit in the management of elderly patients with advanced heart failure.
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- 2015
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50. Prestorage leukoreduction and low-temperature filtration reduce hemolysis of stored red cell concentrates
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S.O. Sowemimo‐Coker, Sandra Weiss, R.B. Garcez, Dana V. Devine, and Maria I.C. Gyongyossy-Issa
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Red Cell ,Immunology ,Erythrocyte fragility ,Cold storage ,Hematology ,Biology ,medicine.disease ,Hemolysis ,law.invention ,Cold Temperature ,Osmotic Fragility ,Red blood cell ,medicine.anatomical_structure ,Leukoreduction ,Blood Preservation ,law ,medicine ,Humans ,Immunology and Allergy ,Food science ,Leukocyte Reduction Procedures ,Filtration - Abstract
BACKGROUND Universal prestorage leukoreduction in Canada created the perception that stored red cells (RBCs) are more hemolyzed than their unfiltered predecessors. A pool-split design tested the effects of leukoreduction on hemolysis of stored RBCs. STUDY DESIGN AND METHODS Two ABO-matched units were pooled, divided, and then processed into leukoreduced (LR) and nonleukoreduced (NLR) units with the Pall LT-WB or RC-PL systems and sampled during standard processing and storage for testing of sterility, counts, hemolysis, and osmotic fragility. RESULTS Room temperature (RT) filtration of 10 pairs of LT-WB-LR and -NLR units showed significantly different percentage of hemolysis (0.39%) and osmotic fragility (0.643%) at 42 days. Cold-stored and -filtered units (2 days at 4 degrees C before processing) were less hemolyzed, but showed a similar proportional decrease of hemolysis in LR units (0.13% vs. 0.25% at 42 days). RBCs from RC-PL systems showed the lowest hemolysis although there was a filtration effect (0.05% vs. 0.12%, 42 days). Osmotic fragility paralleled hemolysis. Segment samples gave inaccurate results. Two-day prefiltration cold storage reduced hemolysis from 0.36 to 0.07 percent (42 days, p < 0.001). RT-LR hemolysis became significantly higher by Day 10 and 4 degrees C LR by Day 12. NLR units showed hemolysis by Day 7. LR units filtered cold were less hemolyzed (p < 0.05) than RT-LR but osmotic fragility was unchanged. CONCLUSIONS LR-RBCs prepared by any of three methods (LT-WB, RT or cold; RC-PL), filtered at 4 degrees C, were less hemolyzed during storage than nonfiltered concentrates: 4 degrees C leukoreduction is beneficial for RBCs and does not cause hemolysis or enhance fragility.
- Published
- 2005
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