7 results on '"Rankin, James M."'
Search Results
2. Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.
- Author
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Dzavík V, Buller CE, Devlin G, Carere RG, Mancini GB, Cantor WJ, Buszman PE, Rankin JM, Vozzi C, Ross JR, Forman S, Barton BA, Lamas AG, and Hochman JS
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- Adult, Aged, Angina Pectoris etiology, Angioplasty, Balloon, Coronary mortality, Canada, Coronary Occlusion diagnostic imaging, Coronary Occlusion mortality, Coronary Occlusion physiopathology, Coronary Restenosis diagnostic imaging, Coronary Restenosis mortality, Coronary Restenosis physiopathology, Female, Heart Failure etiology, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Myocardial Infarction etiology, Platelet Aggregation Inhibitors therapeutic use, Prospective Studies, Prosthesis Design, Risk Assessment, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary instrumentation, Coronary Angiography, Coronary Occlusion therapy, Coronary Restenosis etiology, Drug-Eluting Stents, Metals, Stents
- Abstract
Background: The majority of patients randomized to percutaneous coronary intervention (PCI) in the Occluded Artery Trial (OAT) and its angiographic substudy, the Total Occlusion Study of Canada 2 (TOSCA-2) were treated with bare metal stents (BMS). We aimed to determine if stenting of the target occlusion in OAT with drug-eluting stents (DES) was associated with more favorable angiographic results and clinical outcome when compared with treatment with BMS., Methods: TOSCA-2 DES was a prospective nonrandomized substudy that provided 1-year angiographic comparison of late loss and reocclusion in 25 patients treated with DES and in 128 treated with BMS. In addition, all PCI-assigned patients enrolled from the time when DES were first utilized were similarly categorized (DES n = 77, and BMS n = 386) and compared using the 3-year cumulative OAT primary combined endpoint of death, myocardial infarction, or Class-IV heart failure, as well as angina., Results: In-segment late loss was 0.14 +/- 0.45 mm for DES and 0.75 +/- 0.86 mm for BMS (P < 0.001). Corresponding binary restenosis rates were 13.0% and 44.3% (P = 0.005). Occlusion at 1 year was observed in 4.0 and 12.1%, respectively (P = 0.23). The 3-year cumulative primary event rate was 13.8% with DES and 12.5% with BMS (hazard ratio 1.08, 99% confidence intervals 0.44, 2.64; P = 0.83). Angina over time occurred less frequently in the DES group (P = 0.01)., Conclusions: Although the reduction of late loss and trend to reduction in reocclusion with the use of DES for PCI of persistently occluded IRA 3-28 days post myocardial infarction did not translate into a signal for reduction in death, reinfarction, or Class IV heart failure, DES use was associated with less angina over time. Further follow-up is warranted.
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- 2009
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3. Evaluation of stable chest pain following emergency department presentation: Impact of first‐line cardiac computed tomography diagnostic strategy in an Australian setting.
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Lan, Nick S.R., Thomas, David‐Raj, Jones, Christopher L, Raju, Vikram, Soon, Jeanette, Otto, Jacobus, Wood, Chris, Briffa, Tom, Dwivedi, Girish, Rankin, James M, and Ihdayhid, Abdul Rahman
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CHEST pain diagnosis ,BLOOD vessels ,HOSPITAL emergency services ,SCIENTIFIC observation ,MANN Whitney U Test ,FISHER exact test ,CORONARY angiography ,T-test (Statistics) ,PEARSON correlation (Statistics) ,PRE-tests & post-tests ,RESEARCH funding ,DESCRIPTIVE statistics ,CHI-squared test ,HEALTH care teams ,COMPUTED tomography ,DATA analysis software ,OUTPATIENTS - Abstract
Objective: International guidelines provide increasing support for computed tomography coronary angiography (CTCA) in investigating chest pain. A pathway utilising CTCA first‐line for outpatient stable chest pain evaluation was implemented in an Australian ED. Methods: In pre‐post design, the impact of the pathway was prospectively assessed over 6 months (August 2021 to January 2022) and compared with a 6‐month pre‐implementation group (February 2021 to July 2021). CTCA was recommended first‐line in suspected stable cardiac chest pain, followed by chest pain clinic review. Predefined criteria were provided recommending functional testing in select patients. The impact of CTCA versus functional testing was evaluated. Data were obtained from digital medical records. Results: Three hundred and fifteen patients were included, 143 pre‐implementation and 172 post‐implementation. Characteristics were similar except age (pre‐implementation: 58.9 ± 12.0 vs post‐implementation: 62.8 ± 12.3 years, P = 0.004). Pathway‐guided management resulted in higher first‐line CTCA (73.3% vs 46.2%, P < 0.001), lower functional testing (30.2% vs 56.6%, P < 0.001) and lower proportion undergoing two non‐invasive tests (4.7% vs 10.5%, P = 0.047), without increasing investigation costs or invasive coronary angiography (ICA) (pre‐implementation: 13.3% vs post‐implementation: 9.3%, P = 0.263). In patients undergoing CTCA, 40.7% had normal coronaries and 36.2% minimal/mild disease, with no difference in disease burden post‐implementation. More medication changes occurred following CTCA compared with functional testing (aspirin: P = 0.005, statin: P < 0.001). In patients undergoing ICA, revascularisation to ICA ratio was higher following CTCA compared with functional testing (91.7% vs 18.2%, P < 0.001). No 30‐day myocardial infarction or death occurred. Conclusions: The pathway increased CTCA utilisation and reduced downstream investigations. CTCA was associated with medication changes and improved ICA efficiency. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost‐effective alternative care model: a retrospective cross‐sectional study.
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Alexander, Mikhail, Lan, Nick S R, Dallo, Michael J, Briffa, Tom G, Sanfilippo, Frank M, Hooper, Andrew, Bartholomew, Helen, Hii, Loletta, Hillis, Graham S, McQuillan, Brendan M, Dwivedi, Girish, Rankin, James M, and Ihdayhid, Abdul Rahman
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CORONARY angiography ,MEDICAL care costs ,NON-ST elevated myocardial infarction ,CORONARY care units ,CORONARY artery disease ,CROSS-sectional method - Abstract
Objectives: To examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD. Design: Retrospective cohort study. Setting, participants: Adults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year. Main outcome measures: Severity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment). Results: The mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non‐ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50–69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed‐days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved. Conclusion: Many rural and remote Western Australians transferred for ICA in Perth have non‐obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost‐effective strategy for risk stratification of people with suspected CAD. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Contemporary Chest Pain Evaluation: The Australian Case for Cardiac CT.
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Ihdayhid, Abdul Rahman, Lan, Nick S.R., Figtree, Gemma A., Patel, Sanjay, Arnott, Clare, Hamilton-Craig, Christian, Psaltis, Peter J., Leipsic, Jonathon, Fairbairn, Timothy, Wahi, Sudhir, Hillis, Graham S., Rankin, James M., Dwivedi, Girish, and Nicholls, Stephen J.
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CHEST pain , *CORONARY artery disease , *CORONARY angiography , *COMPUTED tomography , *CORONARY arteries - Abstract
Computed tomography coronary angiography (CTCA) is a non-invasive diagnostic modality that provides a comprehensive anatomical assessment of the coronary arteries and coronary atherosclerosis, including plaque burden, composition and morphology. The past decade has witnessed an increase in the role of CTCA for evaluating patients with both stable and acute chest pain, and recent international guidelines have provided increasing support for a first line CTCA diagnostic strategy in select patients. CTCA offers some advantages over current functional tests in the detection of obstructive and non-obstructive coronary artery disease, as well as for ruling out obstructive coronary artery disease. Recent randomised trials have also shown that CTCA improves prognostication and guides the use of guideline-directed preventive therapies, leading to improved clinical outcomes. CTCA technology advances such as fractional flow reserve, plaque quantification and perivascular fat inflammation potentially allow for more personalised risk assessment and targeted therapies. Further studies evaluating demand, supply, and cost-effectiveness of CTCA for evaluating chest pain are required in Australia. This discussion paper revisits the evidence supporting the use of CTCA, provides an overview of its implications and limitations, and considers its potential role for chest pain evaluation pathways in Australia. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Gender Differences in Coronary Artery Disease Severity and Revascularisation in Patients Referred for Coronary Angiography From Rural and Remote Western Australia.
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Lan, Nick S.R., Alexander, Mikhail, Hillis, Graham S., McQuillan, Brendan M., Briffa, Tom G., Sanfilippo, Frank M., Dwivedi, Girish, Rankin, James M., and Ihdayhid, Abdul Rahman
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CORONARY artery disease , *CORONARY angiography - Published
- 2024
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7. Effects of timing, location and definition of reinfarction on mortality in patients with totally occluded infarct related arteries late after myocardial infarction.
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Adlbrecht, Christopher, Huber, Kurt, Reynolds, Harmony R., Carvalho, Antonio C., Džavík, Vladimír, Steg, Philippe Gabriel, Liu, Li, Marino, Paolo, Pearte, Camille A., Rankin, James M., White, Harvey D., Lamas, Gervasio A., and Hochman, Judith S.
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MYOCARDIAL infarction , *ARTERIAL occlusions , *MORTALITY , *CORONARY angiography , *HEART failure , *RANDOMIZED controlled trials - Abstract
Abstract: Background: The Occluded Artery Trial (OAT) randomized stable patients (n=2201) >24h (calendar days 3–28) after myocardial infarction (MI) with totally occluded infarct-related arteries (IRA), to percutaneous coronary intervention (PCI) with optimal medical therapy, or optimal medical therapy alone (MED). PCI had no impact on the composite of death, reinfarction, or class IV heart failure over extended follow-up of up to 9years. We evaluated the impact of early and late reinfarction and definition of MI on subsequent mortality. Methods and results: Reinfarction was adjudicated according to an adaptation of the 2007 universal definition of MI and the OAT definition (≥2 of the following — symptoms, EKG and biomarkers). Cox regression models were used to analyze the effect of post-randomization reinfarction and baseline variables on time to death. After adjustment for baseline characteristics the 169 (PCI: n=95; MED: n=74) patients who developed reinfarction by the universal definition had a 4.15-fold (95% CI 3.03–5.69, p<0.001) increased risk of death compared to patients without reinfarction. This risk was similar for both treatment groups (interaction p=0.26) and when MI was defined by the stricter OAT criteria. Reinfarctions occurring within 6months of randomization had similar impact on mortality as reinfarctions occurring later, and the impact of reinfarction due to the same IRA and a different epicardial vessel was similar. Conclusions: For stable post-MI patients with totally occluded infarct arteries, reinfarction significantly independently increased the risk of death regardless of the initial management strategy (PCI vs. MED), reinfarction definition, location and early or late occurrence. [Copyright &y& Elsevier]
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- 2014
- Full Text
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