315 results on '"Flaherty, James"'
Search Results
302. Comparison of Continuous Proximal Versus Distal Adductor Canal Blocks for Total Knee Arthroplasty: A Randomized, Double-Blind, Noninferiority Trial.
- Author
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Meier AW, Auyong DB, Yuan SC, Lin SE, Flaherty JM, and Hanson NA
- Subjects
- Administration, Intravenous, Aged, Amides adverse effects, Analgesics, Opioid administration & dosage, Anesthetics, Local adverse effects, Double-Blind Method, Early Ambulation, Female, Humans, Intention to Treat Analysis, Length of Stay, Male, Middle Aged, Morphine administration & dosage, Nerve Block adverse effects, Pain Measurement, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Pain, Postoperative physiopathology, Patient Satisfaction, Prospective Studies, Recovery of Function, Ropivacaine, Time Factors, Treatment Outcome, Ultrasonography, Interventional, Washington, Amides administration & dosage, Anesthetics, Local administration & dosage, Arthroplasty, Replacement, Knee adverse effects, Nerve Block methods, Pain, Postoperative prevention & control
- Abstract
Background and Objectives: Adductor canal blocks (ACBs) are associated with improved analgesia, preserved quadriceps strength, and decreased length of hospitalization after total knee arthroplasty (TKA). However, controversy remains regarding the ideal location of a continuous block within the adductor canal, and it remains unclear whether similar clinical benefits are obtained irrespective of block location. In this randomized, double-blind, noninferiority study, we hypothesized that a continuous proximal ACB provides postoperative analgesia that is no worse than a continuous distal ACB., Methods: Subjects presenting for unilateral TKA were randomized in a 1:1 ratio to either a continuous proximal or distal ACB group. The primary outcome of this noninferiority study was opioid consumption within the first 24 hours following surgery. Secondary outcomes included quadriceps strength, pain scores, distance ambulated, and patient satisfaction., Results: Seventy-three subjects, 36 from the proximal group and 37 from the distal group, completed the study per protocol. The intention-to-treat analysis demonstrated a cumulative mean intravenous morphine equivalent consumption difference between the proximal and distal groups of -7.2 mg (95% confidence interval, -14.8 to 0.4; P < 0.001), demonstrating noninferiority of the proximal approach. The per-protocol analysis yielded similar results: -6.2 mg (95% confidence interval, -14.1 to 1.6; P < 0.001). No secondary outcomes showed statistically significant differences between the proximal and distal groups., Conclusions: This study demonstrates that a continuous proximal ACB offers noninferior postoperative analgesia compared with a distal continuous ACB in the first 24 hours after TKA., Clinical Trial Registration: ClinicalTrials.gov (NCT02701114).
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- 2018
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303. Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement.
- Author
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Huded CP, Benck LR, Stone NJ, Sweis RN, Ricciardi MJ, Malaisrie SC, Davidson CJ, and Flaherty JD
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- Aged, 80 and over, Aortic Valve Stenosis mortality, Cause of Death trends, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Incidence, Male, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Survival Rate trends, Time Factors, Treatment Outcome, United States epidemiology, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage, Postoperative Complications prevention & control, Registries, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy in patients treated with transcatheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary care medical center. We defined high-intensity statin therapy as atorvastatin 40 to 80 mg/day or rosuvastatin 20 to 40 mg/day. Study outcomes included post-TAVR adverse events, 30-day mortality, and overall survival. At the time of TAVR, 14% (n = 41) were on high-intensity statin therapy, 59% (n = 173) were on low- or moderate-intensity statin therapy, and 27% (n = 80) were not on statin therapy. There was no association between statin therapy and the rate of post-TAVR stroke, myocardial infarction, acute kidney injury, in-hospital mortality, or 30-day mortality. At 2 years, 83% of patients in the high-intensity statin group were alive, 70% in the low/moderate-intensity statin group were alive, and 57% in the no statin group were alive (log-rank p = 0.016). In a risk-adjusted model, high-intensity statin therapy was associated with a 64% reduction in all-cause mortality (hazard ratio 0.36, 95% CI 0.14 to 0.90, p = 0.029) compared with no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose-dependent manner., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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304. Lack of Association Between Extracranial Carotid and Vertebral Artery Disease and Stroke After Transcatheter Aortic Valve Replacement.
- Author
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Huded CP, Youmans QR, Puthumana JJ, Sweis RN, Ricciardi MJ, Malaisrie SC, Davidson CJ, and Flaherty JD
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- Aged, Aged, 80 and over, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Female, Humans, Male, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Assessment methods, Risk Factors, Severity of Illness Index, Survival Analysis, Ultrasonography, Doppler, Duplex methods, United States, Carotid Stenosis complications, Carotid Stenosis diagnostic imaging, Postoperative Complications diagnosis, Postoperative Complications mortality, Stroke diagnosis, Stroke epidemiology, Stroke etiology, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods, Vertebrobasilar Insufficiency complications, Vertebrobasilar Insufficiency diagnostic imaging
- Abstract
Background: Carotid artery stenosis is a risk factor for stroke after surgical aortic valve replacement, but it is unknown whether carotid and vertebral artery disease impacts the risk of stroke after transcatheter aortic valve replacement (TAVR)., Methods: We reviewed 294 consecutive cases of TAVR at a tertiary care medical centre. Thirty-one patients without preoperative carotid/vertebral duplex ultrasonograms were excluded. Carotid or vertebral artery disease was defined on the basis of >50% stenosis. Outcomes were stroke within 30 days after TAVR, 30-day mortality, and overall survival., Results: Fifty-one patients (19%) had at least 50% stenosis of a carotid or vertebral artery. The carotid and vertebral artery disease group had higher rates of coronary artery disease, previous coronary artery bypass surgery, and peripheral artery disease compared with the control group. Transfemoral access was less common in the carotid and vertebral artery disease group (55% vs 77%; P < 0.01). Stroke occurred in 6.8% of patients (n = 18) within 30 days after TAVR, but no patients in the carotid and vertebral artery disease group had a stroke. The presence of at least 50% stenosis of a carotid or vertebral artery was not predictive of stroke by logistic regression. There was no difference in 30-day mortality (10% vs 4%; P = 0.11) and overall survival (log-rank test P = 0.84) between the groups., Conclusions: The presence or absence of carotid or vertebral artery stenosis was not significantly related to the occurrence of stroke after TAVR. Routine screening for carotid and vertebral artery disease before TAVR does not appear justified., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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305. Contemporary management of ST-segment elevation myocardial infarction.
- Author
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Yadlapati A, Gajjar M, Schimmel DR, Ricciardi MJ, and Flaherty JD
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- Analgesics pharmacology, Analgesics therapeutic use, Clopidogrel, Humans, Morphine adverse effects, Morphine pharmacology, Morphine therapeutic use, Myocardial Infarction therapy, Percutaneous Coronary Intervention standards, Percutaneous Coronary Intervention statistics & numerical data, Platelet Aggregation Inhibitors pharmacology, Platelet Aggregation Inhibitors therapeutic use, Practice Guidelines as Topic, Prasugrel Hydrochloride adverse effects, Prasugrel Hydrochloride pharmacology, Prasugrel Hydrochloride therapeutic use, Ticlopidine adverse effects, Ticlopidine analogs & derivatives, Ticlopidine pharmacology, Ticlopidine therapeutic use, Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction therapy, Time Factors, Treatment Outcome
- Abstract
ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI. The early administration of newer oral P2Y12 inhibitors, including crushed forms of these agents for faster absorption, represents another treatment advancement. Recent data also suggest avoiding concurrent morphine use due to interactions with P2Y12 inhibitors. Furthermore, new technological advancements and investigational therapies, including Bioresorbable Vascular Scaffolds and the use of pre-intervention intravenous microbubbles with transthoracic ultrasound, hold promise to play a useful role in future STEMI care. Despite these advancements, the prompt recognition of STEMI, at both the patient and health care system level, remains the cornerstone of optimal treatment.
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- 2016
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306. Frailty Status and Outcomes After Transcatheter Aortic Valve Implantation.
- Author
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Huded CP, Huded JM, Friedman JL, Benck LR, Lindquist LA, Holly TA, Sweis RN, Ricciardi MJ, Malaisrie SC, Davidson CJ, and Flaherty JD
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- Aged, Aged, 80 and over, Aortic Valve Stenosis mortality, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Male, Postoperative Period, Prospective Studies, Retrospective Studies, Risk Factors, Survival Rate trends, United States epidemiology, Aortic Valve Stenosis surgery, Frail Elderly, Risk Assessment methods, Transcatheter Aortic Valve Replacement
- Abstract
Frailty is a syndrome of older adults associated with increased morbidity and mortality. We aimed to assess the impact of frailty status on outcomes after transcatheter aortic valve implantation (TAVI). We reviewed all 191 patients who underwent a modified Fried frailty assessment before TAVI between February 2012 and September 2015 at a single academic medical center, and we assessed the impact of preoperative frailty status on morbidity, mortality, and health care utilization after TAVI. Frailty, pre-frailty, and nonfrailty were present in 33% (n = 64), 37% (n = 70), and 30% (n = 57) of patients, respectively. Slowness (75% vs 54%, p = 0.003) and low physical activity (55% vs 31%, p = 0.001) were more common in women than men. With increasing frailty status, the proportion of women increased (35% nonfrail, 44% pre-frail, and 66% frail, p = 0.002) and stature decreased (1.68 ± 0.11 m nonfrail, 1.66 ± 0.11 m pre-frail, 1.62 ± 0.12 m frail, p = 0.028). There was no difference in post-TAVI 30-day mortality, stroke, major vascular injury, major or life-threatening bleeding, respiratory failure, mean hospital length of stay, 30-day hospital re-admission, or overall survival between groups. The rate of discharge to a rehabilitation facility increased with increasing frailty status (14% nonfrail, 22% pre-frail, and 39% frail, p = 0.005). Frailty was independently associated with discharge to a rehabilitation facility (odds ratio 4.80, 95% confidence interval 1.66 to 13.85, p = 0.004). In conclusion, the safety of TAVI is not affected by frailty status, but patients with frailty are less likely to be discharged directly home after TAVI., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2016
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307. Transcatheter Aortic Valve Implantation.
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Malaisrie SC, Iddriss A, Flaherty JD, and Churyla A
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- Cardiac Catheterization, Humans, Patient Selection, Postoperative Complications, Aortic Valve surgery, Aortic Valve Stenosis surgery, Transcatheter Aortic Valve Replacement methods
- Abstract
Severe aortic stenosis (AS) is a life-threatening condition when left untreated. Aortic valve replacement (AVR) is the gold standard treatment for the majority of patients; however, transcatheter aortic valve implantation/replacement (TAVI/TAVR) has emerged as the preferred treatment for high-risk or inoperable patients. The concept of transcatheter heart valves originated in the 1960s and has evolved into the current Edwards Sapien and Medtronic CoreValve platforms available for clinical use. Complications following TAVI, including cerebrovascular events, perivalvular regurgitation, vascular injury, and heart block have decreased with experience and evolving technology, such that ongoing trials studying TAVI in lower risk patients have become tenable. The multidisciplinary team involving the cardiac surgeon and cardiologist plays an essential role in patient selection, procedural conduct, and perioperative care.
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- 2016
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308. Abciximab-induced alveolar hemorrhage treated with rescue extracorporeal membranous oxygenation.
- Author
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Choi AW, Blair JE, and Flaherty JD
- Subjects
- Abciximab, Aged, Antibodies, Monoclonal therapeutic use, Female, Follow-Up Studies, Hemoptysis therapy, Humans, Immunoglobulin Fab Fragments therapeutic use, Myocardial Infarction therapy, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors adverse effects, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Pulmonary Alveoli, Antibodies, Monoclonal adverse effects, Extracorporeal Membrane Oxygenation methods, Hemoptysis chemically induced, Hemostatic Techniques, Immunoglobulin Fab Fragments adverse effects
- Abstract
We describe a case of a 75-year-old woman presenting emergently with an anterior S-T elevation myocardial infarction that deteriorated into ventricular fibrillation requiring prompt resuscitation, resulting in cardiogenic shock. Emergency primary percutaneous coronary intervention of the left anterior descending coronary artery with adjunctive abciximab and heparin resulted in adequate coronary flow, and intra-aortic balloon pump was used to support hemodynamics. Within one hour of intervention, she developed acute respiratory distress with four-quadrant opacification of lung fields, difficulty with oxygenation, and hypotension. Emergency bronchoscopy revealed diffuse erythematous proximal airways with bloody secretions bilaterally confirming diffuse alveolar hemorrhage. An emergency veno-arterial extracorporeal membranous oxygenation (ECMO) circuit was placed at the bedside, acutely improving oxygenation and hemodynamics. She survived the hospitalization with multiple complications related to access site and prolonged intensive care unit stay, was discharged to acute rehabilitation. She is currently thriving 18 months post-procedure. This case highlights the use of ECMO in the often-fatal condition of diffuse alveolar hemorrhage related to glycoprotein inhibitor use., (© 2014 Wiley Periodicals, Inc.)
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- 2015
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309. Role of cardiovascular intervention as a bridge to liver transplantation.
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Raval Z, Harinstein ME, and Flaherty JD
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- Cardiomyopathies therapy, Comorbidity, Coronary Artery Disease therapy, End Stage Liver Disease diagnosis, End Stage Liver Disease epidemiology, Heart Diseases diagnosis, Heart Diseases epidemiology, Heart Diseases physiopathology, Heart Failure therapy, Hemodynamics, Humans, Predictive Value of Tests, Prevalence, Pulmonary Heart Disease therapy, Risk Factors, Treatment Outcome, Waiting Lists, End Stage Liver Disease surgery, Heart Diseases therapy, Liver Transplantation
- Abstract
End stage liver disease (ESLD) is associated with many specific derangements in cardiovascular physiology, which influence perioperative outcomes and may profoundly influence diagnostic and management strategies in the preoperative period. This review focuses on evidence-based diagnosis and management of coronary, hemodynamic and pulmonary vascular disease in this population with an emphasis on specific strategies that may provide a bridge to transplantation. Specifically, we address the underlying prevalence of cardiovascular disease states in the ESLD population, and relevant diagnostic criteria thereof. We highlight traditional and non-traditional predictors of cardiovascular outcomes following liver transplant, as well as data to guide risk-factor based diagnostic strategies. We go on to discuss the alterations in cardiovascular physiology which influence positive- and negative-predictive values of standard noninvasive testing modalities in the ESLD population, and review the data regarding the safety and efficacy of invasive testing in the face of ESLD and its co-morbidities. Finally, based upon the totality of available data, we outline an evidence-based approach for the management of ischemia, heart failure and pulmonary vascular disease in this population. It is our hope that such evidence-driven strategies can be employed to more safely bridge appropriate candidates to liver transplant, and to improve their cardiovascular health and outcomes in the peri-operative period.
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- 2014
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310. Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure.
- Author
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Gheorghiade M, Flaherty JD, Fonarow GC, Desai RV, Lee R, McGiffin D, Love TE, Aban I, Eichhorn EJ, Bonow RO, and Ahmed A
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- Adult, Aged, Chronic Disease, Death, Sudden, Cardiac epidemiology, Female, Hospitalization statistics & numerical data, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Severity of Illness Index, Treatment Outcome, Coronary Artery Bypass mortality, Coronary Artery Disease mortality, Coronary Artery Disease surgery, Heart Failure, Systolic mortality, Heart Failure, Systolic surgery, Myocardial Revascularization mortality
- Abstract
Background: Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs., Methods: Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics., Results: All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P=0.002), 1.44 (0.92-2.25; P=0.114) and 1.76 (1.21-2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P=0.015)., Conclusions: In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD., (Published by Elsevier Ireland Ltd.)
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- 2011
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311. Drug-eluting versus bare-metal stents in unprotected left main coronary artery stenosis a meta-analysis.
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Pandya SB, Kim YH, Meyers SN, Davidson CJ, Flaherty JD, Park DW, Mediratta A, Pieper K, Reyes E, Bonow RO, Park SJ, and Beohar N
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- Aged, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary mortality, Coronary Stenosis mortality, Female, Humans, Kaplan-Meier Estimate, Male, Myocardial Infarction etiology, Odds Ratio, Platelet Aggregation Inhibitors therapeutic use, Prosthesis Design, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Coronary Stenosis therapy, Drug-Eluting Stents, Metals, Stents
- Abstract
Objectives: We undertook a meta-analysis to assess outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) in percutaneous coronary intervention for unprotected left main coronary artery (ULMCA) stenosis., Background: Uncertainty exists regarding the relative performance of DES versus BMS in percutaneous coronary intervention for unprotected left main coronary stenosis., Methods: Of a total of 838 studies, 44 met inclusion criteria (n = 10,342). The co-primary end points were mortality, myocardial infarction (MI), target vessel/lesion revascularization (TVR/TLR), and major adverse cardiac events (MACE: mortality, MI, TVR/TLR)., Results: Event rates for DES and BMS were calculated at 6 to 12 months, at 2 years, and at 3 years. Crude event rates at 3 years were mortality (8.8% and 12.7%), MI (4.0% and 3.4%), TVR/TLR (8.0% and 16.4%), and MACE (21.4% and 31.6%). Nine studies were included in a comparative analysis (n = 5,081). At 6 to 12 months the adjusted odds ratio (OR) for DES versus BMS were: mortality 0.94 (95% confidence interval [CI]: 0.06 to 15.48; p = 0.97), MI 0.64 (95% CI: 0.19 to 2.17; p = 0.47), TVR/TLR 0.10 (95% CI: 0.01 to 0.84; p = 0.01), and MACE 0.34 (95% CI: 0.15 to 0.78; p = 0.01). At 2 years, the OR for DES versus BMS were: mortality 0.42 (95% CI: 0.28 to 0.62; p < 0.01), MI 0.16 (95% CI: 0.01 to 3.53; p = 0.13), and MACE 0.31 (95% CI: 0.15 to 0.66; p < 0.01). At 3 years, the OR for DES versus BMS were: mortality 0.70 (95% CI: 0.53 to 0.92; p = 0.01), MI 0.49 (95% CI: 0.26 to 0.92; p = 0.03), TVR/TLR 0.46 (95% CI: 0.30 to 0.69; p < 0.01), and MACE 0.78 (95% CI: 0.57 to 1.07; p = 0.12)., Conclusions: Our meta-analysis suggests that DES is associated with favorable outcomes for mortality, MI, TVR/TLR, and MACE as compared to BMS in percutaneous coronary intervention for unprotected left main coronary artery stenosis., (Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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312. Defending substantial equivalence: an argument for the continuing validity of the 510(k) premarket notification process.
- Author
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Flaherty JM Jr
- Subjects
- Government Regulation history, History, 20th Century, Humans, United States, United States Food and Drug Administration, Device Approval legislation & jurisprudence, Equipment Safety classification, Equipment and Supplies classification
- Published
- 2008
313. Outcomes and complications associated with off-label and untested use of drug-eluting stents.
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Beohar N, Davidson CJ, Kip KE, Goodreau L, Vlachos HA, Meyers SN, Benzuly KH, Flaherty JD, Ricciardi MJ, Bennett CL, and Williams DO
- Subjects
- Aged, Clopidogrel, Female, Hospital Mortality, Humans, Immunosuppressive Agents administration & dosage, Male, Middle Aged, Platelet Aggregation Inhibitors therapeutic use, Prospective Studies, Risk, Survival Analysis, Ticlopidine analogs & derivatives, Ticlopidine therapeutic use, Treatment Outcome, United States, Angioplasty, Balloon, Coronary, Consumer Product Safety, Paclitaxel administration & dosage, Registries, Sirolimus administration & dosage, Stents adverse effects, Stents statistics & numerical data
- Abstract
Context: Limited data exist regarding use of drug-eluting stents outside of approved indications in real-world settings., Objectives: To determine the frequency, safety, and effectiveness of drug-eluting stents for off-label (restenosis, bypass graft lesion, long lesions, vessel size outside of information for use recommendation) and untested (left main, ostial, bifurcation, or total occlusion lesions) indications in percutaneous coronary intervention (PCI)., Design, Setting, and Patients: Observational, prospective, multicenter registry to evaluate in-hospital, 30-day, and 1-year outcomes among patients undergoing PCI between January and June 2005 in 140 US academic and community medical centers. Of 7752 PCI-treated patients, 6993 (90%) received drug-eluting stents; of these, 5851 (84%) received no other devices. Standard, off-label, and untested use was determined in 5541 (95%) of these 5851 patients, constituting the study cohort., Main Outcome Measures: Frequency of off-label and untested use, 1-year repeat target vessel revascularization, and composite of death, myocardial infarction (MI), or stent thrombosis at in-hospital follow-up and during 1 year of follow-up., Results: Of 5541 patients receiving drug-eluting stents, 2588 (47%) received stents for off-label or untested indications. Adjusted in-hospital risk of death, MI, or stent thrombosis was not statistically different with off-label or untested vs standard use. At 30 days, the risk of this composite end point was significantly higher with off-label use (adjusted hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.24-3.48; P = .005) but not untested use (adjusted HR, 1.45; 95% CI, 0.79-2.67; P = .23). Excluding early events, this end point was not different at 1 year with off-label use (adjusted HR, 1.10; 95% CI, 0.79-1.54; P = .57) or untested use (adjusted HR, 0.91; 95% CI, 0.60-1.38; P = .66). At 1 year, compared with standard use, significantly higher rates of target vessel revascularization were associated with off-label use (adjusted HR, 1.49; 95% CI, 1.13-1.98; P = .005) and untested use (adjusted HR, 1.49; 95% CI, 1.10-2.02; P = .01), although absolute rates were low (standard, 4.4% [n = 113]; off-label, 7.6% [n = 95]; untested, 6.7% [n = 72])., Conclusions: In contemporary US practice, off-label and untested use of drug-eluting stents is common. Compared with standard use, relative early safety is lower with off-label use, and the long-term effectiveness is lower with both off-label and untested use. However, the absolute event rates remain low.
- Published
- 2007
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314. Percutaneous coronary intervention in a patient with cardiac dextroversion.
- Author
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Mehrotra P, Choi JW, Flaherty J, and Davidson CJ
- Abstract
Dextrocardia associated with atrial situs solitus is commonly referred to as dextroversion. Dextroversion is a result of early interruption of normal embryological development and, therefore, rarely occurs without other associated cardiac and noncardiac anomalies. While percutaneous coronary intervention has been described in many cases of dextrocardia with situs inversus, it has not been previously described in dextroversion. We report the case of an 88-year-old woman with dextroversion who presented with an acute anterior myocardial infarction that was successfully treated with coronary stent implantation.
- Published
- 2006
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315. For love of the profession. Award recipients offer pathways to success.
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Gentry SA, Peterson TP, Claffey TF, Flaherty JF, Hayden KR, and Brewster PL
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- United States, Administrative Personnel standards, Awards and Prizes, Leadership, Physician Executives standards, Practice Management, Medical standards
- Abstract
What convictions and ambitions drive certain practice leaders--and certain organizations--to excel and inspire their practices and their peers? Recipients of MGMA and ACMPE's highest honors describe their motivations.
- Published
- 2002
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