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1. Relationship between high shear stress and OCT-verified thin-cap fibroatheroma in patients with coronary artery disease.

Author

Naotaka Okamoto, Yuliya Vengrenyuk, Valentin Fuster, Habib Samady, Keisuke Yasumura, Usman Baber, Nitin Barman, Javed Suleman, Joseph Sweeny, Prakash Krishnan, Roxana Mehran, Samin K Sharma, Jagat Narula, and Annapoorna S Kini

Subjects
Medicine, Science
Abstract

High-risk coronary plaques have been considered predictive of adverse cardiac events. Both wall shear stress (WSS) in patients with hemodynamically significant lesions and optical coherence tomography (OCT) -verified thin-cap fibroatheroma (TCFA) are associated with plaque rupture, the most common underlying mechanism of acute coronary syndrome. The aim of the study was to test the hypothesis that invasive coronary angiography-based high WSS is associated with the presence of TCFA detected by OCT in obstructive lesions. From a prospective study of patients who underwent OCT examination for angiographically obstructive lesions (Yellow II), we selected patients who had two angiographic projections to create a 3-dimensional reconstruction model to allow assessment of WSS. The patients were divided into 2 groups according to the presence and absence of TCFA. Mean WSS was assessed in the whole lesion and in the proximal, middle and distal segments. Of 70 patients, TCFA was observed in 13 (19%) patients. WSS in the proximal segment (WSSproximal) (10.20 [5.01, 16.93Pa]) and the whole lesion (WSSlesion) (12.37 [6.36, 14.55Pa]) were significantly higher in lesions with TCFA compared to WSSproximal (5.84 [3.74, 8.29Pa], p = 0.02) and WSSlesion (6.95 [4.41, 11.60], p = 0.04) in lesions without TCFA. After multivariate analysis, WSSproximal was independently associated with the presence of TCFA (Odds ratio 1.105; 95%CI 1.007-1.213, p = 0.04). The optimal cutoff value of WSSproximal to predict TCFA was 6.79 Pa (AUC: 0.71; sensitivity: 0.77; specificity: 0.63 p = 0.02). Our results demonstrate that high WSS in the proximal segments of obstructive lesions is an independent predictor of OCT-verified TCFA.

Published
2020
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3. Impact of complex percutaneous coronary intervention features on clinical outcomes in patients with or without chronic kidney disease

Author

Huazhen Chen, Alessandro Spirito, Samantha Sartori, Johny Nicolas, Davide Cao, Zhongjie Zhang, Usman Baber, Karim Kamaleldin, Jeffers Guthrie, Birgit Vogel, Joseph Sweeny, Prakash Krishnan, Samin K. Sharma, Annapoorna Kini, George Dangas, and Roxana Mehran

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine
Published
2023

4. Prognostic value of high-sensitivity C-reactive protein among chronic kidney disease patients undergoing percutaneous coronary intervention

Author

Davis Jones, Alessandro Spirito, Samantha Sartori, Kenneth F. Smith, Carlo Andrea Pivato, Mauro Chiarito, Davide Cao, Johny Nicolas, Frans Beerkens, Madison Edens, Brunna Pileggi, Ananya Sen, Zhongjie Zhang, Birgit Vogel, Joseph Sweeny, Usman Baber, George Dangas, Samin K. Sharma, Annapoorna Kini, and Roxana Mehran

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

5. Prognostic Value of Baseline Inflammation in Diabetic and Nondiabetic Patients Undergoing Percutaneous Coronary Intervention

Author

Carlo Andrea Pivato, Davis Jones, Davide Cao, Samantha Sartori, Mauro Chiarito, Johny Nicolas, Zhongjie Zhang, Frans Beerkens, Matteo Nardin, Hanbo Qiu, Victor Razuk, Daniel Feldman, Vaishali Kumaraguru, Giulio G. Stefanini, Joseph Sweeny, Usman Baber, George Dangas, Samin K. Sharma, Annapoorna Kini, and Roxana Mehran

Subjects
Inflammation, C-Reactive Protein, Percutaneous Coronary Intervention, Treatment Outcome, Risk Factors, Diabetes Mellitus, Myocardial Infarction, Humans, Prognosis, Cardiology and Cardiovascular Medicine
Abstract

There is a paucity of data on the prognostic value of high-sensitivity C-reactive protein (hsCRP) levels in diabetic and nondiabetic patients undergoing percutaneous coronary intervention (PCI).All patients with known baseline hsCRP undergoing PCI at a single tertiary care centre from 2010 to 2017 were included. High hsCRP was defined as3 mg/L. Known causes of elevated hsCRP levels and hsCRP10 mg/L represented exclusion criteria. The 1-year primary outcome was major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularisation (TVR).Among a total of 11,979 patients included, high hsCRP levels were observed in 24.7% of patients without diabetes and 29.8% of patients with diabetes (P0.001). Both diabetics and nondiabetics with high hsCRP levels had increased rates of MACE compared with their counterparts with low hsCRP (diabetics: adjusted hazard ratio [aHR] 1.58, 95% CI 1.27-1.96; nondiabetics: aHR 1.45, 95% CI 1.13-1.86; P interaction = 0.981) primarily driven by increased rates all-cause deaths (diabetics: aHR 2.32, 95% CI 1.42-3.80; nondiabetics: aHR 3.14, 95% CI 1.74-5.65; P interaction = 0.415). Although high hsCRP levels were associated with increased rates of TVR (aHR 1.35, 95% CI 1.04-1.75) and MI (aHR 1.86, 95% CI 1.18-2.93) only in patients with diabetes, no significant interactions were observed between inflammation and diabetes (P interaction = 0.749 and 0.602, respectively).Patients undergoing PCI with high levels of hsCRP, defined as3 mg/L, have worse ischemic outcomes regardless of diabetes status.

Published
2022

6. Effect of Elevated C-Reactive Protein on Outcomes After Complex Percutaneous Coronary Intervention for Angina Pectoris

Author

Anton Camaj, Gennaro Giustino, Nikola Kocovic, Davide Cao, Bimmer E. Claessen, Samantha Sartori, Zhongjie Zhang, Hanbo Qiu, Johny Nicolas, Tomoya Hinohara, Usman Baber, David A. Power, Nitin Barman, Joseph Sweeny, George Dangas, Annapoorna Kini, Samin K. Sharma, Roxana Mehran, Cardiology, and ACS - Atherosclerosis & ischemic syndromes

Subjects
C-Reactive Protein, Percutaneous Coronary Intervention, Treatment Outcome, surgical procedures, operative, Risk Factors, Humans, nutritional and metabolic diseases, cardiovascular diseases, Cardiology and Cardiovascular Medicine, Angina Pectoris
Abstract

Inflammation and procedural complexity are individually associated with adverse outcomes after percutaneous coronary intervention (PCI). We aimed to evaluate the association of high sensitivity C-reactive protein (hsCRP) with adverse events according to PCI complexity. We included patients with available hsCRP levels who underwent PCI at our center from 2012 to 2017. We compared patients with hsCRP ≥3 versus 60 mm. The primary end point was major adverse cardiac events (MACEs) (composite of all-cause death, myocardial infarction, or target vessel revascularization) at 1 year. A total of 11,979 patients were included, of which 2,840 (24%) underwent complex PCI. In those, 767 (27%) had hsCRP ≥3 mg/L. The 1-year incidence of MACE was 6% (noncomplex PCI, low hsCRP), 10% (noncomplex PCI, high hsCRP), 10% (complex PCI, low hsCRP), and 15% (complex PCI, high hsCRP). Overall, hsCRP ≥3 mg/L was associated with an increased risk of MACE compared with hsCRP

Published
2022

7. Impact of Race/Ethnicity on Long Term Outcomes After Percutaneous Coronary Intervention with Drug-Eluting Stents

Author

Anastasios Roumeliotis, Bimmer Claessen, Samantha Sartori, Davide Cao, Won-Joon Koh, Hanbo Qiu, Johny Nicolas, Rishi Chandiramani, Ridhima Goel, Mauro Chiarito, Joseph Sweeny, Nitin Barman, Prakash Krishnan, Annapoorna Kini, Samin K Sharma, George Dangas, Roxana Mehran, Cardiology, and ACS - Atherosclerosis & ischemic syndromes

Subjects
Percutaneous Coronary Intervention, Treatment Outcome, Ethnicity, Myocardial Infarction, Humans, ST Elevation Myocardial Infarction, Drug-Eluting Stents, Angina, Unstable, cardiovascular diseases, Acute Coronary Syndrome, Cardiology and Cardiovascular Medicine
Abstract

Cardiovascular disease constitutes the leading cause of mortality worldwide, irrespective of race/ethnicity. Previous studies have shown that minority patients with acute coronary syndrome have distinct clinical, anatomic, and socioeconomic characteristics which may affect clinical outcomes. We included patients who underwent percutaneous coronary intervention with drug-eluting stents for ST-segment elevation myocardial infarction (STEMI), non-STEMI, or unstable angina in a single center. Patients were stratified into Caucasian, African-American, Hispanic, and Asian. Caucasians were the reference group. The primary end point was major adverse cardiac and cerebrovascular events, composite of death, spontaneous myocardial infarction, or stroke at 1 year. Of 6,800 patients included, 49.7% were Caucasian, 20.7% Hispanic, 17.0% Asian and 12.6% African-American. Caucasians were the oldest, Hispanics and Asians had the highest prevalence of diabetes mellitus whereas African-Americans had more chronic kidney disease. Hispanics and African-Americans had the highest STEMI rates, whereas Asians were more likely to present with unstable angina. Compared with Caucasians, Asians had a lower rate of major adverse cardiac and cerebrovascular events at 1 year (3.9% vs 7.1%; p

Published
2022

9. New Criteria to Identify Patients at Higher Risk for Cardiovascular Complications After Percutaneous Coronary Intervention

Author

Alessandro Spirito, Ashutosh Sharma, Davide Cao, Samantha Sartori, Zhongjie Zhang, Johny Nicolas, Carlo Andrea Pivato, Rebecca Cohen, Usman Baber, Joseph Sweeny, Samin K. Sharma, George Dangas, Annapoorna Kini, Sorin J. Brener, and Roxana Mehran

Subjects
Cardiology and Cardiovascular Medicine
Abstract

A universal definition to identify patients at higher risk of complications after percutaneous coronary intervention (PCI) is lacking. We aimed to validate a recently developed score to identify patients at increased risk of all-cause death after PCI. All consecutive patients from a large PCI registry not presenting with ST-elevation myocardial infarction or cardiogenic shock were included. Each patient was assigned a score obtained by summing the points associated with the following variables: age80 years (3 points), dialysis (6 points), left ventricular ejection fraction30% (2 points), and multivessel PCI (2 points). Patients were stratified in 3 groups: low risk (score 0), intermediate risk (score 2 to 3), or high risk (score ≥4). The primary outcome was all-cause death, and the secondary outcomes were major adverse cardiovascular events and major bleeding. Events were assessed at 1 year after PCI. Between January 2014 and December 2019, 12,689 patients underwent PCI. Compared with the 9,884 patients at low risk, those at intermediate and high risk had a fourfold (hazard ratio 3.99, 95% confidence interval 2.95 to 5.38) and ninefold (hazard ratio 9.55, 95% confidence interval 6.89 to 13.2) higher hazard for all-cause death at 1 year, respectively. The score had a good predictive value for all-cause death at 1 year (area under the curve 0.70). The risk of major adverse cardiovascular events and major bleeding increased consistently from the low- to the high-risk group. In conclusion, in patients who underwent PCI for stable ischemic heart disease or non-ST-elevation acute coronary syndrome, a score based on 4 variables well predicted the risk of all-cause death at 1 year.

Published
2022

12. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author

Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura 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Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits

Subjects
Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Published
2020

13. Hemoglobin A1c and Cardiovascular Outcomes Following Percutaneous Coronary Intervention

Author

Samin K. Sharma, Nitin Barman, Usman Baber, Prakash Krishnan, Roxana Mehran, Vaishvi B. Jahveri, Valentin Fuster, Annapoorna Kini, George Dangas, Reza Masoomi, Lorenzo Azzalini, Gurpreet S. Johal, Pooja Vijay, and Joseph Sweeny

Subjects
medicine.medical_specialty, endocrine system diseases, business.industry, medicine.medical_treatment, Absolute risk reduction, nutritional and metabolic diseases, Percutaneous coronary intervention, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, chemistry, Internal medicine, Cohort, Conventional PCI, medicine, 030212 general & internal medicine, Myocardial infarction, Glycated hemoglobin, Cardiology and Cardiovascular Medicine, business, Mace, Glycemic
Abstract

Objectives The aim of this study was to evaluate post–percutaneous coronary intervention (PCI) outcomes in relation to pre-procedural glycated hemoglobin (HbA1c) levels from a large, contemporary cohort. Background There are limited data evaluating associations between HbA1c, a marker of glycemic control, and ischemic risk following PCI. Methods All patients with known HbA1c levels undergoing PCI at a single institution between 2009 and 2017 were included. Patients were divided into 5 groups on the basis of HbA1c level: ≤5.5%, 5.6% to 6.0%, 6.1% to 7.0%, 7.1% to 8.0%, and >8.0%. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death or myocardial infarction (MI), at 1-year follow-up. Results A total of 13,543 patients were included (HbA1c ≤5.5%, n = 1,214; HbA1c 5.6% to 6.0%, n = 2,202; HbA1c 6.1% to 7.0%, n = 4,130; HbA1c 7.1% to 8.0%, n = 2,609; HbA1c >8.0%, n = 3,388). Patients with both low (HbA1c ≤5.5%) and high (HbA1c >8.0%) levels displayed an increased risk for MACE compared with those with values between 6.1% and 7.0%. Excess risk was driven primarily by higher rates of all-cause death among those with low HbA1c levels, while higher values were strongly associated with greater MI risk. Patterns of risk were unchanged among patients with serial HbA1c levels and persisted after multivariate adjustment. Conclusions Among patients undergoing PCI, pre-procedural HbA1c levels display a U-shaped association with 1-year MACE risk, a pattern that reflects greater risk for death in the presence of low HbA1c (≤5.5%) and higher risk for MI with higher values (>8.0%).

Published
2021

14. Mobile application to optimize care for ST-segment elevation myocardial infarction patients in a large healthcare system, STEMIcathAID: rationale and design

Author

Kenny Chu, Joseph Sweeny, Nitin Barman, Brian Wasielewski, Jacqueline E. Tamis-Holland, Ugo Ezenkwele, George Dangas, Bruce J. Darrow, Haydee Garcia, Matthew Bai, Abraham Warshaw, Jeffrey Bander, Umesh Gidwani, Atul Kukar, Samin K. Sharma, Manjit Singh, Beth Oliver, Georgios Syros, Annapoorna Kini, Parasuram Krishnamoorthy, Yuliya Vengrenyuk, Andriy Vengrenyuk, and Usman Baber

Subjects
medicine.medical_specialty, business.industry, Elevation, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Cardiology, ST segment, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, business, Healthcare system
Abstract

Aims Technological advancements have transformed healthcare. System delays in transferring patients with ST-segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) centre are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication, and coordination between the STEMI care teams to reduce ischaemia time and improve patient outcomes. Methods and results The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the electrocardiogram and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer centre. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPAA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge, important data elements have to be entered to close the case. Conclusion We developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

Published
2021

16. Impact of High-Density Lipoprotein Levels on Cardiovascular Outcomes of Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

Author

Adam Reisman, Samin K. Sharma, Bimmer E. Claessen, Ridhima Goel, Nitin Barman, Mauro Chiarito, Rebecca Torguson, Johny Nicolas, Rishi Chandiramani, Roxana Mehran, Madhav Sharma, Davide Cao, Dhrubajyoti Bandyopadhyay, Usman Baber, Anastasios Roumeliotis, Samantha Sartori, George Dangas, Annapoorna Kini, and Joseph Sweeny

Subjects
Male, Drug, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, New York, Coronary Artery Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, Percutaneous Coronary Intervention, 0302 clinical medicine, High-density lipoprotein, Risk Factors, Internal medicine, medicine, Humans, In patient, Registries, cardiovascular diseases, 030212 general & internal medicine, Aged, Retrospective Studies, media_common, business.industry, Incidence, Percutaneous coronary intervention, Drug-Eluting Stents, Middle Aged, Prognosis, Survival Rate, surgical procedures, operative, chemistry, Conventional PCI, Cardiology, Female, lipids (amino acids, peptides, and proteins), Lipoproteins, HDL, Cardiology and Cardiovascular Medicine, business, Cardiovascular outcomes, Biomarkers, Follow-Up Studies, Lipoprotein
Abstract

Low levels of high-density lipoprotein (HDL) have been associated with adverse cardiovascular events in epidemiologic studies. Evidence regarding its role in patients who underwent percutaneous coronary intervention (PCI) is scarce. We evaluated consecutive patients who underwent PCI with drug-eluting stents from 2012 to 2017, excluding those with unavailable baseline HDL, age18 years, presentation with ST-segment elevation myocardial infarction (MI) or shock, and coexisting neoplastic disease. The final population was stratified according to baseline HDL levels into reduced and nonreduced HDL cohorts, with cut-off value 40 mg/dl in males and 50 mg/dl in females. The primary end point was 1-year major adverse cardiovascular events (MACE), defined as the composite of death, MI, or target vessel revascularization (TVR). Among 10,843 patients included, 6,511 (60%) had reduced HDL, and 4,332 (40%) nonreduced HDL. The rate of 1-year MACE was similar between the 2 groups (7.5% vs 6.6%; p = 0.14). Although mortality and MI rates were comparable, reduced HDL was associated with significantly higher TVR 5.2% vs 4.0%; p = 0.02, a finding that attenuated after multivariable adjustment (adjusted hazard ratio 1.18, p = 0.14). Sex subgroup analysis included 7,718 (71.2%) males and 3,125 (28.8%) females. Among men, there was a trend toward higher MACE in those with reduced HDL (7.4% vs 6.0%; p = 0.08) mostly driven by TVR (5.4% vs 3.7%; p = 0.005). No association between HDL and 1-year outcomes was evident in females. Assessment for interaction between sex and reduced HDL did not reach statistical significance. In conclusion, reduced baseline HDL was not associated with increased risk of MACE in a contemporary PCI population.

Published
2020

17. Prognostic Impact of High-Sensitivity C-Reactive Protein in Patients Undergoing Percutaneous Coronary Intervention According to BMI

Author

Samin K. Sharma, George Dangas, Zhongjie Zhang, Niklas Beyhoff, Anastasios Roumeliotis, Vishal Kapur, Samantha Sartori, Prakash Krishnan, Moritz Blum, Davide Cao, Ridhima Goel, Joseph Sweeny, Rishi Chandiramani, Jason C. Kovacic, Nitin Barman, Roxana Mehran, Usman Baber, and Annapoorna Kini

Subjects
medicine.medical_specialty, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Overweight, Body Mass Index, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, education.field_of_study, biology, business.industry, C-reactive protein, nutritional and metabolic diseases, Percutaneous coronary intervention, Prognosis, medicine.disease, C-Reactive Protein, Treatment Outcome, Conventional PCI, biology.protein, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Body mass index, Mace
Abstract

The aim of this study was to determine the prevalence and prognostic implications of elevated high-sensitivity C-reactive protein (hsCRP) in patients undergoing percutaneous coronary intervention (PCI) according to body mass index (BMI).Whereas elevated hsCRP predicts adverse clinical outcome after PCI in the general population, the impact of BMI on its prognostic utility remains unclear.Data from 14,140 patients who underwent PCI between January 2009 and June 2017 at a large tertiary care center were analyzed. Patients were divided into 4 BMI categories: normal (BMI 18.5 to 25 kg/mElevated hsCRP was present in 18.9%, 23.6%, 33.3%, and 47.7% of the normal, overweight, obese, and severely obese groups, respectively. MACE rates were consistently higher in patients with elevated hsCRP across all BMI categories (normal, 13.4% vs. 8.3%; overweight, 11.2% vs. 7.2%; obese, 10.6% vs. 7.5%; severely obese, 11.9% vs. 6.5%; p 0.01 for all). After multivariate adjustment, hsCRP elevation remained significantly associated with MACE independent of BMI (hazard ratios: normal, 1.43 [95% confidence interval: 1.04 to 1.95]; overweight, 1.56 [95% confidence interval: 1.21 to 1.88]; obese, 1.40 [95% confidence interval: 1.06 to 1.84]; severely obese, 1.92 [95% confidence interval: 1.35 to 2.75]; p 0.05 for all).Among patients undergoing PCI, the prevalence of hsCRP elevation progressively increased with higher BMI. Measurement of hsCRP facilitates prognostic risk assessment for adverse outcome after PCI across a broad range of BMI.

Published
2020

19. Deploying a novel custom mobile application for STEMI activation and transfer in a large healthcare system to improve cross-team workflow. STEMIcathAID implementation project

Author

Haydee Garcia, Bernadette Springer, Andriy Vengrenyuk, Parasuram Krishnamoorthy, Derek Pineda, Brian Wasielewski, Wilfred AS Tan, Ashley D'Amiento, Julianna Bastone, Nitin Barman, Jeffrey Bander, Joseph Sweeny, George Dangas, Umesh Gidwani, Yuliya Vengrenyuk, Ugo Ezenkwele, Abraham Warshaw, Atul Kukar, Kevin Chason, Michael Redlener, Matthew Bai, Jennifer Siller, and Annapoorna S. Kini

Subjects
Myocardial Infarction, Humans, ST Elevation Myocardial Infarction, Pilot Projects, Cardiology and Cardiovascular Medicine, Delivery of Health Care, Mobile Applications, Workflow
Abstract

ST-segment elevation myocardial infarction (STEMI) is a high-risk patient medical emergency. We developed a secure mobile application, STEMIcathAID, to optimize care for STEMI patients by providing a digital platform for communication between the STEMI care team members, EKG transmission, cardiac catherization laboratory (cath lab) activation and ambulance tracking. The aim of this report is to describe the implementation of the app into the current STEMI workflow in preparation for a pilot project employing the app for inter-hospital STEMI transfer.App deployment involved key leadership stakeholders from all multidisciplinary teams taking care of STEMI patients. The team developed a transition plan addressing all aspects of the health system improvement process including the workflow analysis and redesign, app installation, personnel training including user account access to the app, and development of a quality assurance program for progress evaluation. The pilot will go live in the Emergency Department (ED) of one of the hospitals within the Mount Sinai Hospital System (MSHS) during the daytime weekday hours at the beginning and extending to 24/7 schedule over 4-6 weeks. For the duration of the pilot, ED personnel will combine the STEMIcathAID app activation with previous established STEMI activation processes through the MSHS Clinical Command Center (CCC) to ensure efficient and reliable response to a STEMI alert. More than 250 people were provisioned app accounts including ED Physicians and frontline nurses, and trained on their user-specific roles and responsibilities and scheduled in the app. The team will be provided with a feedback form that is discipline specific to complete after every STEMI case in order to collect information on user experience with the STEMIcathAID app functionality. The form will also provide quantitative metrics for the key time sensitive steps in STEMI care.We developed a uniform approach for deployment of a mobile application for STEMI activation and transfer in a large urban healthcare system to optimize the clinical workflow in STEMI care. The results of the pilot will demonstrate whether the app has a significant impact on the quality of care for transfer of STEMI patients.

Published
2022

20. Cardiovascular outcomes after percutaneous coronary intervention on bifurcation lesions with moderate to severe coronary calcium: A <scp>single‐center</scp> registry study

Author

Vishal Kapur, Prakash Krishnan, Yuliya Vengrenyuk, Pooja Vijay, Joseph Sweeny, Roxana Mehran, Naotaka Okamoto, Samin K. Sharma, Vaishvi Jhaveri, Melissa Aquino, George Dangas, Usman Baber, Nileshkumar J. Patel, Jonathan Luke Murphy, Annapoorna Kini, Nitin Barman, and Choudhury Hasan

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Hazard ratio, Percutaneous coronary intervention, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Angiography, Conventional PCI, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Mace, Calcification
Abstract

Background Both target vessel calcification and target vessel bifurcation are associated with worse outcomes following percutaneous coronary intervention (PCI). Whether these entities in combination interact to influence outcomes after PCI of complex coronary disease is not known. Objectives This study evaluated the association of target vessel bifurcation and target vessel calcification, alone and in combination, with adverse events following PCI. Methods Registry data from 21,165 patients who underwent PCI with drug-eluting stents (DES) between January 2009 and December 2017 were analyzed. Patients were divided into four groups according to the presence or absence of target vessel bifurcation and presence of none/mild or moderate/severe target vessel calcification on angiography. Associations between lesion groups and 1 year major adverse cardiac events (MACE) were examined using Cox regression analysis. Results At 1 year, unadjusted rates of MACE, death, myocardial infarction (MI), as well as stent thrombosis were highest in the group with both bifurcation lesion and moderate/severe calcification. After adjusting for confounders such as age, renal disease, and smoking, hazard ratios for MACE were 1.14 (95%CI 0.99-1.33) for bifurcation with none/mild calcification, 1.21 (95%CI 1.06-1.38) for no bifurcation and moderate/severe calcification, and 1.37 (95%CI 1.14-1.64) for bifurcation and moderate severe calcification, compared to patients with no bifurcation and none/mild calcification. Conclusions The presence of a bifurcating target vessel with moderate/severe calcification is associated with a higher risk of adverse outcomes than either attribute alone. New approaches are needed to improve outcomes in this subset of patients with complex coronary artery disease.

Published
2020

21. Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft

Author

Anton Camaj, Samin K. Sharma, Mauro Chiarito, Annapoorna Kini, Usman Baber, Matteo Nardin, Joseph Sweeny, Clayton Snyder, David A. Power, Samantha Sartori, Bimmer E. Claessen, Ranbir Singh, Prakash Krishnan, Carlo Andrea Pivato, George Dangas, Davis Jones, Anne H. Tavenier, Victor Razuk, Roxana Mehran, Nitin Barman, Davide Cao, Gennaro Giustino, Johny Nicolas, Frans Beerkens, Cardiology, and ACS - Atherosclerosis & ischemic syndromes

Subjects
medicine.medical_specialty, Time Factors, saphenous vein graft interventions, medicine.medical_treatment, Target vessel, Coronary Artery Disease, law.invention, saphenous vein bypass graft, Randomized controlled trial, law, Risk Factors, Internal medicine, complex PCI, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, Myocardial infarction, cardiovascular diseases, Coronary Artery Bypass, business.industry, percutaneous coronary intervention, Percutaneous coronary intervention, General Medicine, medicine.disease, medicine.anatomical_structure, Treatment Outcome, surgical procedures, operative, coronary bypass grafts, Conventional PCI, Cardiology, no reflow, Cardiology and Cardiovascular Medicine, business, Mace, Artery
Abstract

Objectives: To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery. Background: Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown. Methods: We stratified prior CABG patients who underwent PCI at a tertiary-care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post-PCI. Results: Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow- and no-reflow phenomenon was more common in venous graft PCI compared to native vessel PCI (OR 4.78; 95% CI 2.56–8.95; p < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. Conclusions: Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.

Published
2021

22. Sex-Related Differences in the Prevalence and Prognostic Value of the Academic Research Consortium for High Bleeding Risk Criteria

Author

Samin K. Sharma, Joseph Sweeny, Hanbo Qiu, Roxana Mehran, Davide Cao, Rishi Chandiramani, Usman Baber, Giuseppe De Luca, Matteo Nardin, Mauro Chiarito, Samantha Sartori, George Dangas, Giulio G. Stefanini, Johny Nicolas, Zhongjie Zhang, Ekta Golani, and Annapoorna Kini

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Sex related, Hemorrhage, Prognosis, Risk Assessment, Percutaneous Coronary Intervention, Risk Factors, Internal medicine, Female patient, medicine, Prevalence, Humans, Cardiology and Cardiovascular Medicine, business, Value (mathematics), Risk criteria
Abstract

Background: Bleeding events after percutaneous coronary intervention are associated with substantial morbidity and mortality. Female patients undergoing percutaneous coronary intervention are often older and present with a higher burden of comorbidities, which in turn increases their risk of adverse events, including bleeding complications. The Academic Research Consortium (ARC) have proposed a list of clinical criteria to define high bleeding risk (HBR). Our aim was to evaluate the prevalence and predictive value of the ARC-HBR criteria according to sex in a contemporary cohort of patients undergoing percutaneous coronary intervention. Methods: All consecutive patients receiving coronary stenting between 2014 and 2017 at a tertiary-care center were defined as HBR if they fulfilled at least 1 major or 2 minor ARC-HBR criteria. The primary bleeding end point was the composite of periprocedural in-hospital or postdischarge bleeding up to 1 year. Individual components of the primary bleeding end point, all-cause mortality, and myocardial infarction were also evaluated. Results: Of the total 9623 patients, 6979 (72.5%) were male and 2644 (27.5%) female. The prevalence of HBR was significantly higher in females compared with males (56.5% versus 39.9%, P P P interaction =0.344). The ARC-HBR criteria associated with the highest bleeding risk at 1 year were severe/end-stage chronic kidney disease and thrombocytopenia in females, and moderate/severe anemia in males. Conclusions: In a real-world cohort of percutaneous coronary intervention patients, females were more often at HBR than males. The prognostic value of the ARC-HBR definition was consistent between female and male patients, despite sex-related differences in the prevalence and bleeding risk associated with individual ARC-HBR criteria.

Published
2021

27. Prevalence and Impact of High Bleeding Risk in Patients Undergoing Left Main Artery Disease PCI

Author

Zhongjie Zhang, Roxana Mehran, Samin K. Sharma, Davide Cao, George Dangas, David A. Power, Giulio G. Stefanini, Tafadzwa Mtisi, Usman Baber, Johny Nicolas, Joseph Sweeny, Mauro Chiarito, Anastasios Roumeliotis, Samantha Sartori, Annapoorna Kini, Matteo Nardin, Adam Reisman, and Gennaro Giustino

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Disease, Arteries, Coronary Artery Disease, medicine.anatomical_structure, Percutaneous Coronary Intervention, Treatment Outcome, Risk Factors, Internal medicine, Conventional PCI, medicine, Prevalence, Humans, In patient, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Artery
Abstract

The aim of this study was to determine the prevalence and prognostic impact of high bleeding risk (HBR), as determined by the Academic Research Consortium HBR criteria, in real-world patients undergoing left main (LM) percutaneous coronary intervention (PCI).LM PCI is often reserved for patients at increased risk for periprocedural adverse events. Patients at HBR represent a relevant percentage of this cohort, but their outcomes after LM PCI are still poorly investigated.All patients undergoing LM PCI between 2014 and 2017 at a tertiary care center were prospectively enrolled. Patients were defined as having HBR if they met at least 1 major or 2 minor Academic Research Consortium HBR criteria. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months.Among 619 enrolled patients, 55.3% were at HBR. The rate of the primary endpoint was 4-fold higher in patients at HBR compared with those without HBR (20.5% vs 4.9%; HR: 4.43; 95% CI: 2.31-8.48), driven by an increased risk for all-cause death (HR: 3.88; 95% CI: 1.88-8.02) and MI (HR: 6.18; 95% CI: 1.83-20.9). Rates of target vessel or lesion revascularization and stent thrombosis were comparable in the 2 groups. Bleeding occurred more frequently in patients at HBR (HR: 3.77; 95% CI: 1.83-7.76). Consistent findings were observed after Cox multivariable regression adjustment.Among patients undergoing LM PCI, those with HBR are at increased risk for all-cause death, MI, and bleeding. Conversely, rates of repeat revascularization and stent thrombosis were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.

Published
2021

28. Impact of sex on long‐term cardiovascular outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes

Author

Roxana Mehran, Bimmer E. Claessen, Joseph Sweeny, Prakash Krishnan, Davide Cao, Johny Nicolas, Rebecca Torguson, Samin K. Sharma, Anastasios Roumeliotis, Samantha Sartori, Mauro Chiarito, Annapoorna Kini, George Dangas, Hanbo Qiu, Rishi Chandiramani, Nitin Barman, Anton Camaj, and Ridhima Goel

Subjects
Male, Bare-metal stent, Acute coronary syndrome, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, Humans, Medicine, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, education, education.field_of_study, business.industry, Unstable angina, Percutaneous coronary intervention, Drug-Eluting Stents, General Medicine, medicine.disease, Treatment Outcome, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business
Abstract

BACKGROUND Women with acute coronary syndrome (ACS) generally present with more comorbidities and experience worse clinical outcomes compared with males. However, it is unclear whether this represents genuine sex-related difference or stems from clinical, procedural and socioeconomic factors. METHODS We analyzed consecutive patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), non-STEMI or unstable angina at a single tertiary-care center. Exclusion criteria were unknown sex, age

Published
2021

29. Outcomes by Gender and Ethnicity After Percutaneous Coronary Intervention

Author

Usman Baber, George Dangas, Jaya Chandrasekhar, Bimmer E. Claessen, Samantha Sartori, Roxana Mehran, Melissa Aquino, Nitin Barman, Prakash Krishnan, Pedro R. Moreno, Samin K. Sharma, Pooja Vijay, Jason C. Kovacic, Joseph Sweeny, Annapoorna Kini, Asha M. Mahajan, and Cardiology

Subjects
Male, Reoperation, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Lower risk, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Sex Factors, Internal medicine, medicine, Ethnicity, Humans, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Incidence (epidemiology), Incidence, Hazard ratio, Percutaneous coronary intervention, Middle Aged, medicine.disease, Survival Rate, Treatment Outcome, Socioeconomic Factors, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Limited data on gender differences by ethnicity after percutaneous coronary intervention (PCI) exist. In this prospective cohort study, we examined gender differences in 1-year outcomes among patients from 4 ethnic groups who underwent PCI from 2010 to 2016 at a tertiary center. The primary outcome was 1-year major adverse cardiovascular events (MACE) defined as composite of all-cause death, nonfatal myocardial infarction (MI), or target lesion revascularization. Secondary outcomes included composite of death or MI and individual components of MACE. Baseline characteristics and outcomes were compared between gender in each ethnic group. The study included 16,361 patients: 7,881 whites (26.1% women), 1,943 blacks (47.3% women), 2,621 Asians (22.6% women), and 3,916 Hispanics (39.3% women). Women were older with more co-morbidities than men. Unadjusted, women had higher incidence of 1-year MACE than men among whites and Asians but not blacks or Hispanics, which was driven by a greater incidence of death in white women and greater incidence of MI in Asian women compared with male counterparts. After adjustment, findings showed similar risk of 1-year MACE in women versus men in whites, Asians, and Hispanics (Whites: hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.78 to 1.16; Asians: HR 1.14, 95% CI 0.77 to 1.67; Hispanics: HR 0.97, 95% CI 0.74 to 1.27). Black women had lower risk of 1-year MACE compared with black men (HR 0.67, 95% CI 0.46 to 0.97), driven by lower risk of death or MI. In conclusion, this study suggests that risk factors account for adverse events in women after PCI.

Published
2019

30. Residual Inflammatory Risk in Patients With Low LDL Cholesterol Levels Undergoing Percutaneous Coronary Intervention

Author

Samin K. Sharma, Jason C. Kovacic, Birgit Vogel, Prakash Krishnan, Roxana Mehran, Joseph Sweeny, Melissa Aquino, Serdar Farhan, Paul Guedeney, George Dangas, Annapoorna Kini, Bimmer E. Claessen, Gennaro Giustino, Gilles Montalescot, Nitin Barman, Usman Baber, Samantha Sartori, Deborah N. Kalkman, Sabato Sorrentino, Cardiology, ACS - Atherosclerosis & ischemic syndromes, Graduate School, and ACS - Heart failure & arrhythmias

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Coronary Artery Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Clinical endpoint, Humans, In patient, Registries, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, Stroke, Aged, Retrospective Studies, Inflammation, business.industry, Percutaneous coronary intervention, Cholesterol, LDL, Middle Aged, medicine.disease, C-Reactive Protein, Increased risk, Conventional PCI, Cardiology, Female, Low LDL cholesterol, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract

Background: Data on the impact of residual inflammatory risk (RIR) in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl are scarce. Objectives: The purpose of this study was to characterize the prevalence and impact of persistent high RIR after PCI in patients with baseline LDL-C ≤70 mg/dl. Methods: All patients undergoing PCI between January 2009 and December 2016 in a single tertiary center, with baseline LDL-C ≤70 mg/dl and serial high-sensitivity C-reactive protein (hsCRP) assessments (at least 2 measurements ≥4 weeks apart) were retrospectively analyzed. High RIR was defined as hsCRP >2 mg/l. Patients were categorized as persistent low RIR (first low then low hsCRP), attenuated RIR (first high then low hsCRP), increased RIR (first low then high hsCRP), or persistent high RIR (first high then high hsCRP). Primary endpoint of interest was major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke), within 1 year of the second hsCRP measurement. Results: A total of 3,013 patients were included, with persistent low, attenuated, increased, and persistent high RIR in 1,225 (41.7%), 414 (13.7%), 346 (11.5%), and 1,028 (34.1%) patients, respectively. Overall, there was a stepwise increase in the incidence rates of MACCE, transitioning from the persistent low to the attenuated, increased, and persistent high RIR (respectively, 64.4 vs. 96.6 vs. 138.0 vs. 152.4 per 1,000 patient-years; p < 0.001). After adjustment, the presence of persistent high RIR remained strongly associated with MACCE (adjusted hazard ratio: 2.10; 95% confidence interval: 1.45 to 3.02; p < 0.001). Conclusions: Among patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high RIR is frequent and is associated with increased risk of MACCE. Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI.

Published
2019

31. Calculated Serum Osmolality, Acute Kidney Injury, and Relationship to Mortality after Percutaneous Coronary Intervention

Author

Samin K. Sharma, Madhav Sharma, Melissa Aquino, Serdar Farhan, Jaya Chandrasekhar, George Dangas, Usman Baber, Birgit Vogel, Roxana Mehran, Annapoorna Kini, Gennaro Giustino, Joseph Sweeny, Paul Guedeney, Nitin Barman, Reyna Bhandari, Sabato Sorrentino, Miklos Rohla, and Samantha Sartori

Subjects
Male, medicine.medical_specialty, Urology, medicine.medical_treatment, 030232 urology & nephrology, Coronary Artery Disease, 030204 cardiovascular system & hematology, Single Center, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Risk Factors, Cause of Death, Internal medicine, medicine, Clinical endpoint, Humans, Blood urea nitrogen, Aged, Retrospective Studies, business.industry, Osmolar Concentration, Acute kidney injury, Percutaneous coronary intervention, Acute Kidney Injury, Middle Aged, medicine.disease, United States, Survival Rate, Creatinine, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Kidney disease
Abstract

Background: Data on the associations between serum osmolality (sOsmo) and acute kidney injury (AKI) as well as short- and long-term mortality in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are limited. Objectives: To investigate the association between sOsmo and development of AKI and clinical outcomes in patients undergoing PCI. Methods: We investigated 1,927 consecutive patients undergoing PCI from the registry of a single center. Patients were divided into quartiles according to sOsmo at admission (Q1–Q4). sOsmo was calculated using the following equation: (1.86 × serum sodium [mmol/L]) + (glucose [mg/dL] / 18) + (blood urea nitrogen [mg/dL] / 2.8) + 9. The primary endpoint was AKI, per Kidney Disease: Improving Global Outcomes (KDIGO) definition. The secondary endpoints were 30-day and 1-year all-cause mortality. Results: Patients with the highest sOsmo (Q4) were older and more likely female, with significantly more cardiovascular risk factors and comorbidities compared to those with lower sOsmo (Q1–Q3). Incidence of AKI was highest in Q4 and lowest in Q2. In the multivariate logistic regression model, high sOsmo independently predicted the development of AKI (OR 2.00, 95% CI 1.26–3.19, p = 0.003). Patients with Q4 had a higher risk of 1-year mortality compared to patients with Q2 (HR 2.11, 95% CI 1.10–4.15; p = 0.031), but not after adding AKI to the multivariate model (HR 1.71, 95% CI 0.87–3.39; p = 0.12). Conclusion: sOsmo is a valid and easily obtainable predictor of AKI after PCI. High sOsmo is associated with increased risk of AKI and 1-year mortality in patients undergoing PCI. Further research is warranted to clarify whether the use of an sOsmo-directed hydration protocol might reduce the incidence of AKI in patients undergoing PCI.

Published
2019

32. Temporal trends, determinants, and impact of high-intensity statin prescriptions after percutaneous coronary intervention

Author

Nitin Barman, Paul Guedeney, Sabato Sorrentino, George Dangas, Usman Baber, Michela Faggioni, Pooja Vijay, Pedro R. Moreno, Roxana Mehran, Joseph Sweeny, Bimmer E. Claessen, Annapoorna Kini, Jaya Chandrasekhar, Birgit Vogel, Jason C. Kovacic, Anton Camaj, Melissa Aquino, Serdar Farhan, Samin K. Sharma, Srushthi Shah, and Deborah N. Kalkman

Subjects
medicine.medical_specialty, Statin, medicine.drug_class, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Odds ratio, 030204 cardiovascular system & hematology, Single Center, medicine.disease, Angina, 03 medical and health sciences, 0302 clinical medicine, Conventional PCI, Emergency medicine, medicine, Rosuvastatin, cardiovascular diseases, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Prospective cohort study, business, medicine.drug
Abstract

Background High-intensity statins (HIS) are recommended for secondary prevention following percutaneous coronary intervention (PCI). We aimed to describe temporal trends and determinants of HIS prescriptions after PCI in a usual-care setting. Methods All patients with age ≤75 years undergoing PCI between January 2011 and May 2016 at an urban, tertiary care center and discharged with available statin dosage data were included. HIS were defined as atorvastatin 40 or 80 mg, rosuvastatin 20 or 40 mg, and simvastatin 80 mg. Results A total of 10,495 consecutive patients were included. Prevalence of HIS prescriptions nearly doubled from 36.6% in 2011 to 60.9% in 2016 (P Conclusion Although the rate of HIS prescriptions after PCI has increased in recent years, important heterogeneity remains and should be addressed to improve practices in patients undergoing PCI.

Published
2019

33. TCT-472 Deploying a Custom STEMI Transfer Application in a Large Health Care System to Improve Cross-Team Work Flow

Author

Derek Pineda, Michael Redlener, Haydee Garcia, Julianna Bastone, Annapoorna Kini, Nitin Barman, Matthew Bai, Abraham Warshaw, Parasuram Krishnamoorthy, Joseph Sweeny, Atul Kukar, Kevin Chason, Jennifer Siller, Bernadette Springer, Andriy Vengrenyuk, and Jeffrey Bander

Subjects
Teamwork, Flow (mathematics), business.industry, media_common.quotation_subject, Health care, Medicine, Operations management, Cardiology and Cardiovascular Medicine, business, media_common
Published
2021

34. Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention

Author

Usman Baber, Jaya Chandrasekhar, Roxana Mehran, Sabato Sorrentino, Nitin Barman, Joseph Sweeny, George Dangas, Gennaro Giustino, Paul Guedeney, Serdar Farhan, Samin K. Sharma, Annapoorna Kini, Birgit Vogel, Anton Camaj, Bimmer E. Claessen, and Samantha Sartori

Subjects
Male, Risk, medicine.medical_specialty, medicine.medical_treatment, Population, Myocardial Infarction, Hemorrhage, 030204 cardiovascular system & hematology, Malignancy, Risk Assessment, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, Humans, Medicine, In patient, 030212 general & internal medicine, Myocardial infarction, education, Aged, Out of hospital, education.field_of_study, business.industry, Age Factors, Percutaneous coronary intervention, Thrombosis, Hematology, Middle Aged, medicine.disease, Patient Discharge, United States, Conventional PCI, Female, business, Risk assessment, Follow-Up Studies
Abstract

Background Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. Methods We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. Results In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p Conclusion Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.

Published
2018

36. Acute Coronary Syndrome: STEMI and Non-STEMI Interventions

Author

Joseph Sweeny and Amit Hooda

Subjects
medicine.medical_specialty, Invasive strategy, Acute coronary syndrome, Unstable angina, business.industry, Psychological intervention, medicine.disease, Non stemi, Internal medicine, Conventional PCI, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Thrombus, business
Abstract

Acute coronary syndrome is a spectrum ranging from ST-elevation myocardial infarction to troponin-negative unstable angina. Plaque rupture or erosion leads to thrombus formation resulting in ischemic myocardial damage. Current guidelines recommend primary angioplasty for patients with STEMI and early invasive strategy (

Published
2021

37. Performance of the academic research consortium high-bleeding risk criteria in patients undergoing PCI for acute myocardial infarction

Author

Usman Baber, Samin K. Sharma, Frans Beerkens, Bimmer E. Claessen, Roxana Mehran, Matteo Nardin, Anton Camaj, Johny Nicolas, Davide Cao, Victor Razuk, Annapoorna Kini, Mauro Chiarito, Hanbo Qiu, David A. Power, Bryana Banashefski, Gennaro Giustino, Zhongjie Zhang, Carlo Andrea Pivato, George Dangas, Davis Jones, Joseph Sweeny, Samantha Sartori, and Cardiology

Subjects
medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Aftercare, Percutaneous coronary intervention, Risk Factors, Internal medicine, medicine, Humans, In patient, Myocardial infarction, cardiovascular diseases, Stage (cooking), Risk criteria, Hematology, business.industry, medicine.disease, Patient Discharge, ARC-HBR, Treatment Outcome, Conventional PCI, High bleeding risk, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Kidney disease
Abstract

Patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) are at increased risk for thrombotic and bleeding complications compared to patients with chronic coronary syndrome (CCS). The academic research consortium (ARC) recently suggested a set of criteria to identify patients at high bleeding risk (HBR). We sought to evaluate the performance of the ARC-HBR criteria among patients undergoing PCI according to clinical presentation. We included all consecutive patients undergoing PCI at a tertiary-care center. Patients were deemed at HBR if they fulfilled ≥ 1 major or ≥ 2 minor ARC-HBR criteria. The primary bleeding endpoint was a composite of in-hospital or post-discharge bleeding at 1-year follow-up. Secondary outcomes included all-cause death and myocardial infarction. Out of 6068 patients, 1391 (22.9 %) presented with AMI and were more often at HBR than those with CCS (46.9 % vs. 43.0 %, p = 0.01). HBR patients had a higher risk for the primary bleeding endpoint than non-HBR, irrespective of the clinical indication for PCI (AMI: 19.5 % vs. 5.5 %; HR 3.86, 95 % CI 2.63–5.69; CCS: 6.8 % vs. 2.6 %; HR 2.65, 95 % CI 1.92–3.68; p-interaction = 0.11). Secondary outcomes followed a similar trend. After multivariable adjustment, AMI presentation remained significantly associated with increased risk for bleeding at 1 year (HR 1.64, 95 % CI 1.13–2.38, p = 0.01). The ARC-HBR criterion associated with the highest bleeding risk was severe/end-stage chronic kidney disease in AMI and moderate/severe anemia in CCS. The ARC-HBR framework successfully identified AMI and CCS patients with increased risk for bleeding complications at 1 year post-PCI. Graphical abstract: [Figure not available: see fulltext.]

Published
2021

38. Prevalence and prognostic impact of hsCRP elevation are age‐dependent in women but not in men undergoing percutaneous coronary intervention

Author

George Dangas, Nitin Barman, Samin K. Sharma, Usman Baber, Sebastian Kelle, Jason C. Kovacic, Prakash Krishnan, Anastasios Roumeliotis, Samantha Sartori, Rishi Chandiramani, Roxana Mehran, Moritz Blum, Davide Cao, Niklas Beyhoff, Joseph Sweeny, Ridhima Goel, and Annapoorna Kini

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Risk Factors, Internal medicine, Prevalence, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, education, education.field_of_study, Proportional hazards model, business.industry, nutritional and metabolic diseases, Percutaneous coronary intervention, General Medicine, Middle Aged, Prognosis, medicine.disease, C-Reactive Protein, Treatment Outcome, Quartile, Conventional PCI, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

BACKGROUND High-sensitivity C-reactive protein (hsCRP) predicts outcomes after percutaneous coronary intervention (PCI). OBJECTIVE We studied the prevalence and prognostic impact of hsCRP elevation according to age in men and women undergoing PCI. METHODS We included patients undergoing PCI at our center from 2010 until 2017, excluding those with myocardial infarction (MI) on presentation, neoplastic disease and hsCRP >10 mg/L at baseline. Elevated hsCRP was defined as >3 mg/L. The outcome of interest was major adverse cardiac events (MACE) consisting of all-cause death, MI and target vessel revascularization. The association between hsCRP elevation and outcomes was assessed using adjusted Cox models. RESULTS 10,432 men and 4,345 women were included. Elevation of hsCRP was present in 25.7% of men and 37.0% of women (p

Published
2020

39. Abstract 16507: Complex Percutaneous Coronary Intervention Features Worsen Prognosis in Diabetic Patients: Insights From a Large Single-center Registry

Author

Anastasios Roumeliotis, Samantha Sartori, Prakash Krishnan, Samin K. Sharma, Mauro Chiarito, Johny Nicolas, Zhongjie Zhang, Bimmer E. Claessen, Ridhima Goel, Annapoorna Kini, Hanbo Qiu, Joseph Sweeny, David A. Power, Rishi Chandiramani, George Dangas, Usman Baber, Roxana Mehran, Davide Cao, and Matteo Nardin

Subjects
medicine.medical_specialty, business.industry, Physiology (medical), medicine.medical_treatment, Emergency medicine, medicine, Percutaneous coronary intervention, Cardiology and Cardiovascular Medicine, Single Center, business
Abstract

Introduction: Despite the increasing number of complex percutaneous coronary interventions (CPCI), data regarding outcomes following CPCI in patients with diabetes mellitus (DM) are scarce. Hypothesis: Compared to the general population, diabetic patients undergoing CPCI have worse prognosis. Methods: We analyzed data of patients who underwent PCI in a tertiary-care center between 2009 and 2017. Patients were divided into 2 groups (CPCI and non-CPCI) stratified by presence of DM. CPCI was defined as having ≥1 of the following: stent length >60 mm, ≥3 stents implanted, ≥3 lesions, ≥3 target vessels, bifurcation with ≥2 stents, or chronic total occlusion. The main outcome was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR) at 1 year. Results: Out of 20,412 patients included, 5,038 (24.7%) underwent CPCI. Patients with DM constituted 46.5% (n=9,494) of the overall cohort and 44.5% (n=2,240) of CPCI group. Among patients undergoing CPCI, diabetics were younger, more likely to be female, and had more cardiovascular risk factors (kidney disease, dyslipidemia, and hypertension) than non-diabetics. In addition, diabetic patients had more advanced coronary disease (multivessel disease, high syntax score, and longer lesion length). At 1 year, diabetic patients had higher risk of MACE than non-diabetic, regardless of PCI complexity ( Figure 1 ). Nonetheless, there was a significant interaction between CPCI and diabetes in terms of mortality at 1 year (p-interaction=0.009). In contrast, compared to non-diabetics, a higher risk of TVR ( adj HR 1.49, 95% CI [1.24 - 1.78], p adj HR 1.45, 95% CI [1.05 - 1.98], p=0.02) was observed in diabetics undergoing non-CPCI but not CPCI. Conclusion: Diabetic patients are at higher risk of MACE than the general population regardless of PCI complexity. Yet, 1-year mortality is substantially higher in diabetics undergoing CPCI than non-CPCI.

Published
2020

40. Abstract 16570: Systemic Inflammation Alters the Bleeding-Ischemic Balance in High-Bleeding Risk Patients Undergoing Percutaneous Coronary Interventions

Author

Ridhima Goel, Usman Baber, Hanbo Qiu, Rishi Chandiramani, Roxana Mehran, George Dangas, Davide Cao, Samin K. Sharma, Bimmer E. Claessen, Annapoorna Kini, Prakash Krishnan, Matteo Nardin, Anastasios Roumeliotis, Samantha Sartori, Mauro Chiarito, Johny Nicolas, Zhongjie Zhang, Anton Camaj, and Joseph Sweeny

Subjects
Percutaneous, business.industry, Physiology (medical), Anesthesia, medicine, Psychological intervention, cardiovascular diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, Systemic inflammation, business, Balance (ability)
Abstract

Introduction: Prognosis in high-bleeding risk (HBR) patients after percutaneous coronary intervention (PCI) is largely dependent on risk of ischemic/bleeding events. Inflammation is known to increase the ischemic risk following PCI in the general population, yet its impact on HBR patients remains unknown. Hypothesis: We assessed the hypothesis that inflammation, as reflected by elevated high-sensitivity C - reactive protein (hsCRP), increases the risk of ischemic and bleeding events in HBR patients undergoing PCI. Methods: We included patients who underwent PCI at a tertiary care center between 2014 and 2017. Patients were classified as HBR if they met ≥1 major or ≥2 minor criteria according to the Academic Research Consortium (ARC)-HBR consensus. Patients were then stratified into high (≥3 mg/l) and low (10 mg/l were excluded. The main outcomes of interest were major adverse cardiac events (MACE) (composite of all-cause death, MI, and target vessel revascularization) and bleeding events. Results: Out of 7,186 patients included, 3,403 (42.3%) fulfilled the ARC-HBR definition of whom 1,046 (34.4%) had high hsCRP. These patients were frequently female, younger, and had more cardiovascular risk factors (diabetes, kidney disease, and peripheral artery disease) yet similar angiographic features (multivessel disease, syntax score, and lesion length) than those with low hsCRP. Although risk of MACE at 1 year was similar in HBR patients with either high or low hsCRP, mortality risk was significantly higher in the former group ( Figure 1 ). In addition, HBR patients with high hsCRP were more likely to have periprocedural bleeding (OR 1.72, 95% CI [1.14-2.58], p=0.01) but similar risk of 1-year major bleeding as HBR patients with low hsCRP ( Figure 1 ). Conclusion: In conclusion, inflammation is associated with periprocedural bleeding and 1-year mortality in HBR patients undergoing PCI.

Published
2020

41. Abstract 16599: Impact of Race and Ethnicity on Long Term Outcomes Post Percutaneous Coronary Intervention With Drug Eluting Stents

Author

Mauro Chiarito, Prakash Krishnan, George Dangas, Nitin Barman, Joseph Sweeny, Hanbo Qiu, Samin K. Sharma, Rishi Chandiramani, Won-Joon Koh, Anastasios Roumeliotis, Roxana Mehran, Johny Nicolas, Samantha Sartori, Davide Cao, Ridhima Goel, Annapoorna Kini, and Bimmer E. Claessen

Subjects
Drug, medicine.medical_specialty, business.industry, media_common.quotation_subject, medicine.medical_treatment, Ethnic group, Percutaneous coronary intervention, Race (biology), Physiology (medical), Emergency medicine, Long term outcomes, medicine, Cardiology and Cardiovascular Medicine, business, media_common
Abstract

Introduction: Cardiovascular disease is the leading cause of mortality worldwide, irrespective of race/ethnicity. Previous studies reported that minority patients with ACS have distinct clinical, genetic and socioeconomic backgrounds that may affect clinical outcomes. Hypothesis: To investigate post percutaneous coronary intervention (PCI) outcomes according to race/ethnicity in a contemporary ACS population. Methods: We included consecutive patients undergoing drug-eluting stent implantation for STEMI, non-STEMI or unstable angina (UA) between 2012-2017. The study population was stratified into Caucasian, African American, Hispanic and Asian. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, spontaneous myocardial infarction or stroke at 1 year. Results: Of the 6800 patients included, 3377 (49.7%) were Caucasian, 1408 (20.7%) Hispanic, 1156 (17.0%) Asian and 859 (12.6%) African American. Caucasians were the oldest, Hispanics and Asians had the highest prevalence of diabetes mellitus (DM) and African Americans had more insulin dependent DM and chronic kidney disease. Hispanics and African Americans had the highest STEMI rate, while Asians were more likely to present with UA, have private insurance and be discharged on aspirin and clopidogrel. Compared to Caucasians, Asians had a lower rate of MACCE at 1 year (3.9% vs. 7.1%; p Conclusions: Among patients undergoing PCI for ACS, Asian race is associated with favorable cardiovascular outcomes compared to Caucasian. No significant differences were observed for Hispanics and African Americans.

Published
2020

42. Impact of high-density lipoprotein levels in males and females undergoing percutaneous coronary intervention with drug eluting stents

Author

Samin K. Sharma, Ridhima Goel, George Dangas, Davide Cao, J Nicolas, Joseph Sweeny, Samantha Sartori, Nitin Barman, Usman Baber, Annapoorna Kini, Rishi Chandiramani, A Roumeliotis, Roxana Mehran, A Reisman, and Bimmer E. Claessen

Subjects
Drug, Cardiovascular event, medicine.medical_specialty, business.industry, medicine.medical_treatment, media_common.quotation_subject, Coronary arteriosclerosis, Percutaneous coronary intervention, medicine.disease, Revascularization, chemistry.chemical_compound, High-density lipoprotein, chemistry, Internal medicine, Shock (circulatory), Diabetes mellitus, medicine, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, media_common
Abstract

Background/Introduction Low levels of high-density lipoprotein (HDL) have been associated with adverse cardiovascular events in multiple epidemiological studies. Evidence regarding the role of HDL in males and females with established coronary artery disease undergoing percutaneous coronary intervention (PCI) with drug eluting stents (DES) is scarce. Purpose We sought to investigate the impact of low HDL levels on 1-year cardiovascular outcomes in males and females undergoing PCI with DES. Methods We screened all patients undergoing PCI in our center from 2012 to 2017. Exclusion criteria were: unavailable baseline HDL measurement, age Results Out of the 10,843 patients included, 7,718 (71.2%) were male and 3,125 (28.8%) were female. Low HDL was noted in 58.5% of males and 63.8% of females. Patients with low HDL were younger and had a higher prevalence of DM, prior MI, smoking and multi-vessel disease. When comparing low to high HDL groups in terms of 1-year MACE a borderline significant difference was shown in males (7.4% vs. 6.0%; p-value=0.08) but not in females (7.7% vs 8.1%; p-value=0.90) [Panel A]. The numerically higher incidence of MACE in males with low HDL was primarily driven by TVR (5.4% vs 3.7%; p-value=0.005) while the rates of Death (1.4% vs. 1.3%; p=0.96) and MI (2.0% vs. 1.8%; p-value=0.89) were similar between the two groups. After adjustment the male low HDL subgroup remained at a higher risk for 1-year TVR but not 1-year MACE compared to the male high HDL subgroup [Panel B]. No difference for any individual component of MACE was shown between low and high HDL subgroups in females [Panel C]. Conclusion(s) High HDL levels were associated with a lower incidence of TVR and borderline reduction of MACE in male but not female patients undergoing PCI with DES. No difference was demonstrated in terms of death or MI between the high and low HDL subgroups at 1-year follow-up. Impact of HDL levels according to gender Funding Acknowledgement Type of funding source: None

Published
2020

43. Side branch FFR after provisional stenting: simplified approach based on OCT frame count

Author

Samin K. Sharma, Gregg W. Stone, Vishal Kapur, Keisuke Yasumura, Samit Bhatheja, Yuliya Vengrenyuk, Roxana Mehran, Usman Baber, Joseph Sweeny, Nitin Barman, Naotaka Okamoto, Annapoorna Kini, and Choudhury Hasan

Subjects
business.industry, Side branch, Frame (networking), Medicine, Cardiology and Cardiovascular Medicine, business, Algorithm
Abstract

Background/Introduction Treatment of bifurcation coronary artery lesions remains a major challenge in interventional cardiology. Side branch (SB) stenoses are frequently observed after stent implantation in bifurcation lesions, although angiographically narrowed SBs may not be functionally significant. Fractional flow reserve (FFR), a pressure-derived index of the hemodynamic significance of a coronary artery stenosis, may be useful in determining whether additional intervention is required in jailed SBs. Angiography and intravascular ultrasound (IVUS) derived parameters have showed poor diagnostic accuracy in predicting the functional significance of jailed SBs. Purpose The aim of the present study was to use high resolution optical coherence tomography (OCT) imaging to predict functionally significant SB stenoses after provisional stenting defined as SB FFR ≤0.80. Methods Seventy-one patients with 71 calcified bifurcation lesions with angiographically intermediate SB stenoses undergoing provisional stenting were enrolled in the prospective study. OCT pullbacks were performed before and after stent placement, and SB FFR was measured after main vessel stenting. SB ostium area (SBOA) was assessed using three-dimensional OCT cut-plane analysis off-line. In addition, we developed a simplified approach to SB ostium assessment based on SB ostium frame count using two-dimensional OCT pullback not requiring off-line 3D reconstruction. For the analysis, consecutive frames were counted between the most distal and most proximal take-off of the SB frames. Results Similar to previous studies, quantitative coronary angiography findings were not associated with the functional significance of SBs after main vessel stenting. In contrast, SBOA assessed by 3D-OCT after provisional stenting strongly correlated with post-procedure SB FFR. The optimal cut-off value for the SBOA area to predict a SB FFR ≤0.80 was 0.76 mm2 (sensitivity 82%, specificity 89% and area under the curve of 0.92 (95% CI: 0.84–0.99). A simplified approach to SB ostium assessment using OCT frame count yielded a sensitivity of 82%, specificity 89% and area under the curve 0.92 (95% CI: 0.84 to 0.99) with a cut-off of 4.5 frames allowing detection of functionally significant SB stenoses during the procedure in real time. Figure 1 shows a receiver-operating characteristic curve for SB FFR ≤0.8 and a representative case with SB FFR = 0.66 after provisional stenting and SB ostium frame count equal 3 (Frame 1 to 3) Conclusion(s) Assessment of SB using either 3D OCT off-line reconstruction or a simplified approach based on OCT frame count can detect SB branches with FFR ≤0.80 with high sensitivity and specificity. The developed approaches may represent a useful tool to assess provisional stent outcomes. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific; St. Jude Medical

Published
2020

44. A sex paradox in clinical outcomes following complex percutaneous coronary intervention

Author

Johny Nicolas, Matteo Nardin, Usman Baber, Birgit Vogel, Hanbo Qiu, Mauro Chiarito, Roxana Mehran, Rishi Chandiramani, Bimmer E. Claessen, Samin K. Sharma, Prakash Krishnan, Ali Turfah, Joseph Sweeny, George Dangas, Annapoorna Kini, Nitin Barman, Davide Cao, Ridhima Goel, Anastasios Roumeliotis, and Samantha Sartori

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Target vessel revascularization, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Retrospective Studies, business.industry, Confounding, Stent, Percutaneous coronary intervention, Drug-Eluting Stents, medicine.disease, Treatment Outcome, Conventional PCI, Female, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Background Although the number of complex percutaneous coronary intervention (CPCI) procedures is increasing, data regarding sex-related outcomes following CPCI are scarce. Methods We retrospectively analyzed data of patients enrolled in a single-center registry between 2009 and 2017. Patients were divided into two groups (CPCI and non-CPCI) stratified by sex. CPCI was defined as any PCI procedure with ≥1 of the following characteristics: ≥3 target vessels/lesions, ≥3 stents implanted, bifurcation with ≥2 stents, stent length > 60 mm, or chronic total occlusion. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target vessel revascularization, at oneon-year follow-up. Results Among 20,419 patients, 5004 (24.5%) underwent CPCI of whom 25.6% (n = 1281) women and 74.4% (n = 3723) men. Women presented with more comorbidities yet less complex coronary anatomy than men (syntax score: 19.5 ± 10.3 vs. 20.6 ± 10.7, p = 0.009). Moreover, women were more likely to fulfill a single rather than multiple CPCI criteria. At one year, a higher rate of MACE occurred in women (14.0% vs. 11.6%, p = 0.02). After multivariable adjustment for confounders, the risk of MACE at one year was similar among both sexes (HR:1.04, 95% CI [0.85–1.26], p = 0.71), without significant interaction between the complexity of the procedure and sex (p-interaction = 0.96). Nonetheless, the risk of MI was significantly higher in women than men undergoing CPCI (HR:1.63, 95% CI [1.12–2.38], p = 0.01). Conclusions Despite presenting with less challenging lesions than men, women had a higher rate of MI at one year following CPCI, even after adjusting for potential confounders.

Published
2020

45. Combined and independent impact of coronary artery calcification and inflammation on risk for adverse cardiovascular events after percutaneous coronary intervention: Results from a large single‐center registry

Author

Usman Baber, Pooja Vijay, Joseph Sweeny, Nitin Barman, Shunsuke Aoi, Annapoorna Kini, George Dangas, Jason C. Kovacic, Pedro R. Moreno, Roxana Mehran, Srushti Shah, Samin K. Sharma, Melissa Aquino, and Icahn School of Medicine at Mount Sinai [New York] (MSSM)

Subjects
Male, Time Factors, Databases, Factual, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Myocardial Infarction, Coronary Artery Disease, 030204 cardiovascular system & hematology, Systemic inflammation, Single Center, Severity of Illness Index, 0302 clinical medicine, Risk Factors, 030212 general & internal medicine, Myocardial infarction, Registries, systemic inflammation, General Medicine, cardiovascular event, 3. Good health, C-Reactive Protein, Treatment Outcome, Cardiology, Female, medicine.symptom, Inflammation Mediators, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Inflammation, Risk Assessment, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Adverse effect, Vascular Calcification, Aged, Retrospective Studies, business.industry, coronary calcification, Percutaneous coronary intervention, nutritional and metabolic diseases, medicine.disease, Conventional PCI, New York City, business, Mace, Biomarkers
Abstract

International audience; Purpose: Our study investigated the impact of coronary artery calcification (CAC) and systemic inflammation on risks for major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI).Background: CAC and systemic inflammation are known to be associated with an increased risk of cardiovascular events.Methods: A total of 17,711 consecutive patients who underwent PCI in our hospital between January 1, 2009 and December 31, 2015 were categorized according to the degree of CAC (moderate/severe vs. none/mild) and high-sensitivity C-reactive protein (hsCRP) level (≥2 vs.

Published
2020

46. Procedural and 1-year clinical outcomes of orbital atherectomy for treatment of coronary in-stent restenosis: A single-center, retrospective study

Author

Vishal Kapur, Nitin Barman, Artiom Petrov, Roxana Mehran, Samin K. Sharma, Yuliya Vengrenyuk, Annapoorna Kini, Benjamin Benhuri, Usman Baber, Gregg W. Stone, Javed Suleman, Keisuke Yasumura, and Joseph Sweeny

Subjects
Atherectomy, Coronary, medicine.medical_specialty, Atherectomy, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, Coronary Restenosis, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Restenosis, Angioplasty, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Retrospective Studies, business.industry, Percutaneous coronary intervention, General Medicine, Debulking, medicine.disease, Surgery, Treatment Outcome, Conventional PCI, Stents, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Objectives We evaluated the procedural and 1-year clinical outcomes of orbital atherectomy (OA) for treatment of coronary in-stent restenosis (ISR). Background The optimal treatment for ISR remains uncertain. While rotational and laser atherectomy have been used as neointimal debulking techniques for ISR, there have been few reports on OA for ISR. Methods This is a retrospective observational study of consecutive patients who underwent percutaneous coronary intervention (PCI) for ISR with OA in Mount Sinai catheterization laboratory between November 2013 and January 2018. Procedural success was defined as angiographic success without in-hospital major adverse cardiac events (MACE; the composite of all-cause death, myocardial infarction [MI], or target vessel revascularization). Clinical outcomes were assessed at 1 month and 12 months postprocedure. Results A total of 87 patients were included in the study. All 87 patients were treated with OA, after which 49 (56.3%) patients also received new drug-eluting stents. Angiographic success was achieved in 87 (100%) patients and procedural success was achieved in 79 (90.8%) patients. In-hospital MACE occurred in 8 (9.2%) patients, all due to periprocedural non-Q-wave MI. Acute lumen gain was 1.19 ± 0.57 mm after OA plus balloon angioplasty and 1.75 ± 0.50 mm after stent placement. MACE within 1 year occurred in 17 (19.5%) patients. Conclusions OA for ISR was performed with favorable procedural and 1-year clinical outcomes. Randomized trials are warranted to determine whether OA improves the poor prognosis of patients with ISR treated without debulking.

Published
2020

47. Side branch fractional flow reserve after provisional stenting of calcified bifurcation lesions: The ORBID-FFR study

Author

Vishal Kapur, Samin K. Sharma, Nitin Barman, Keisuke Yasumura, Samit Bhatheja, Choudhury Hasan, Yuliya Vengrenyuk, Naotaka Okamoto, Roxana Mehran, Joseph Sweeny, Surbhi Chamaria, Annapoorna Kini, Usman Baber, and Gregg W. Stone

Subjects
medicine.medical_treatment, Fractional flow reserve, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Lesion, 03 medical and health sciences, 0302 clinical medicine, Angioplasty, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, business.industry, Coronary Stenosis, General Medicine, Thrombolysis, medicine.disease, Coronary Vessels, Fractional Flow Reserve, Myocardial, Stenosis, Ostium, Treatment Outcome, Cutting balloon, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract

OBJECTIVES We examined the incidence of side branch (SB) compromise after provisional stenting of calcified bifurcation lesions treated with rotational atherectomy (RA) or cutting balloon angioplasty (CBA) and the utility of optical coherence tomography (OCT) to detect functionally significant SB stenoses. BACKGROUND The comparative impact of RA versus CBA on SB compromise and functional significance remains poorly characterized. METHODS Seventy-one consecutive patients with 71 calcified bifurcation lesions with angiographically intermediate SB stenoses were randomized to RA (n = 35) or CBA (n = 36). The primary endpoint was SB compromise defined as SB diameter stenosis ≥70%, SB dissection or thrombolysis in myocardial infarction flow grade

Published
2020

48. Validation of the Academic Research Consortium High Bleeding Risk Definition in Contemporary PCI Patients

Author

Roxana Mehran, Joseph Sweeny, Usman Baber, Marie-Claude Morice, Giulio G. Stefanini, Dominick J. Angiolillo, George Dangas, Ridhima Goel, Mitchell W. Krucoff, Rishi Chandiramani, Davide Capodanno, Philip Urban, Annapoorna Kini, Davide Cao, Samin K. Sharma, Anastasios Roumeliotis, and Samantha Sartori

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, 030204 cardiovascular system & hematology, Risk Assessment, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Risk Factors, Internal medicine, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Myocardial infarction, Aged, Aged, 80 and over, business.industry, Patient Selection, Percutaneous coronary intervention, Coronary stenting, Middle Aged, medicine.disease, Prognosis, Increased risk, Conventional PCI, Cohort, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Bleeding following percutaneous coronary intervention has important prognostic implications. The Academic Research Consortium (ARC) recently proposed a list of clinical criteria to define patients at high bleeding risk (HBR).This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort.Patients undergoing coronary stenting between 2014 and 2017 at a tertiary-care center were defined as HBR if they met at least 1 major or 2 minor ARC-HBR criteria. To account for the presence of multiple criteria, patients were further stratified by the number of times they fulfilled the ARC-HBR definition. The primary endpoint was a composite of peri-procedural in-hospital or post-discharge bleeding at 1 year. Secondary endpoints included individual components of the primary bleeding endpoint, myocardial infarction, and all-cause mortality.Among 9,623 patients, 4,278 (44.4%) qualified as HBR. Moderate or severe anemia was the most common major criterion (33.2%); age ≥75 years was the most frequent minor criterion and the most common overall (46.8%). The rate of the primary bleeding endpoint at 1 year was 9.1% in HBR patients compared with 3.2% in non-HBR patients (p 0.001), with a stepwise increase in bleeding risk corresponding to the number of times the ARC-HBR definition was fulfilled. HBR patients also experienced significantly higher rates of all secondary endpoints.This study validates the ARC-HBR definition in a contemporary group of patients who underwent percutaneous coronary intervention. The ARC-HBR definition identified patients at increased risk not only for bleeding but also for thrombotic events, including all-cause mortality. Coexistence of multiple ARC-HBR criteria showed additive prognostic value.

Published
2020

49. Relationship between high shear stress and OCT-verified thin-cap fibroatheroma in patients with coronary artery disease

Author

Habib Samady, Prakash Krishnan, Roxana Mehran, Keisuke Yasumura, Naotaka Okamoto, Yuliya Vengrenyuk, Usman Baber, Javed Suleman, Nitin Barman, Valentin Fuster, Annapoorna Kini, Jagat Narula, Joseph Sweeny, and Samin K. Sharma

Subjects
Male, Hemodynamics, Coronary Artery Disease, 030204 cardiovascular system & hematology, Cardiovascular Medicine, Coronary Angiography, Biochemistry, Vascular Medicine, Diagnostic Radiology, Coronary artery disease, White Blood Cells, 0302 clinical medicine, Spectrum Analysis Techniques, Medical Conditions, Animal Cells, Medicine and Health Sciences, Coronary Heart Disease, 030212 general & internal medicine, Myocardial infarction, Prospective cohort study, Shear Stresses, Tomography, Coronary Arteries, Multidisciplinary, Physics, Radiology and Imaging, Classical Mechanics, near-Infrared Spectroscopy, Arteries, Middle Aged, Lipids, Plaque, Atherosclerotic, Cardiovascular Diseases, Physical Sciences, cardiovascular system, Cardiology, Mechanical Stress, Medicine, Female, medicine.symptom, Cellular Types, Anatomy, Tomography, Optical Coherence, circulatory and respiratory physiology, Research Article, medicine.medical_specialty, Acute coronary syndrome, Imaging Techniques, Immune Cells, Science, Immunology, Infrared Spectroscopy, Research and Analysis Methods, Lesion, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, Internal medicine, medicine, Humans, Aged, Blood Cells, business.industry, Macrophages, Biology and Life Sciences, Cell Biology, medicine.disease, Stenosis, Thin-cap fibroatheroma, Lesions, Cardiovascular Anatomy, Blood Vessels, Clinical Medicine, business, Tunica Intima
Abstract

High-risk coronary plaques have been considered predictive of adverse cardiac events. Both wall shear stress (WSS) in patients with hemodynamically significant lesions and optical coherence tomography (OCT) -verified thin-cap fibroatheroma (TCFA) are associated with plaque rupture, the most common underlying mechanism of acute coronary syndrome. The aim of the study was to test the hypothesis that invasive coronary angiography-based high WSS is associated with the presence of TCFA detected by OCT in obstructive lesions. From a prospective study of patients who underwent OCT examination for angiographically obstructive lesions (Yellow II), we selected patients who had two angiographic projections to create a 3-dimensional reconstruction model to allow assessment of WSS. The patients were divided into 2 groups according to the presence and absence of TCFA. Mean WSS was assessed in the whole lesion and in the proximal, middle and distal segments. Of 70 patients, TCFA was observed in 13 (19%) patients. WSS in the proximal segment (WSSproximal) (10.20 [5.01, 16.93Pa]) and the whole lesion (WSSlesion) (12.37 [6.36, 14.55Pa]) were significantly higher in lesions with TCFA compared to WSSproximal (5.84 [3.74, 8.29Pa], p = 0.02) and WSSlesion (6.95 [4.41, 11.60], p = 0.04) in lesions without TCFA. After multivariate analysis, WSSproximal was independently associated with the presence of TCFA (Odds ratio 1.105; 95%CI 1.007–1.213, p = 0.04). The optimal cutoff value of WSSproximal to predict TCFA was 6.79 Pa (AUC: 0.71; sensitivity: 0.77; specificity: 0.63 p = 0.02). Our results demonstrate that high WSS in the proximal segments of obstructive lesions is an independent predictor of OCT-verified TCFA.

Published
2020

50. Prognostic Relation Between Severity of Diabetes Mellitus (On or Off Insulin) ± Chronic Kidney Disease with Cardiovascular Risk After Percutaneous Coronary Intervention

Author

Annapoorna Kini, Samin K. Sharma, Roxana Mehran, Yuliya Vengrenyuk, Nitin Barman, Samit Bhatheja, Surbhi Chamaria, Hasan Choudhury, Usman Baber, and Joseph Sweeny

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Severity of Illness Index, Angina Pectoris, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, Diabetes mellitus, Diabetes Mellitus, Humans, Hypoglycemic Agents, Insulin, Medicine, Angina, Stable, Angina, Unstable, 030212 general & internal medicine, Myocardial infarction, Mortality, Renal Insufficiency, Chronic, Non-ST Elevated Myocardial Infarction, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, business.industry, Hazard ratio, Percutaneous coronary intervention, Type 2 Diabetes Mellitus, Middle Aged, Prognosis, medicine.disease, Cardiovascular Diseases, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Female, Cardiology and Cardiovascular Medicine, business, Kidney disease
Abstract

The presence of either diabetes mellitus (DM) or chronic kidney disease (CKD) is associated with a worse prognosis after percutaneous coronary intervention (PCI). It is also known that outcomes in patients treated with insulin (insulin requiring type 2 diabetes mellitus [ITDM]) are worse than those who are not on insulin (non-insulin type 2 diabetes mellitus [NITDM]). We sought to compare long-term outcomes in patients who underwent PCI with varying severity of DM with and without CKD. We retrospectively studied 17,898 patients who underwent PCI from January 2009 to December 2014 in the Mount Sinai Cath Lab. Patients were categorized into groups by the presence or the absence of CKD and by the DM status (none, NITDM, or ITDM). In the absence of CKD, adjusted hazard ratios (95% confidence interval [CI]) for death or myocardial infarction associated with NITDM and ITDM were 1.65 (95% CI 1.02 to 2.67) and 3.78 (95% CI 2.23 to 6.40), respectively. Analogous risks in the presence of CKD were 3.34 (95% CI 1.99 to 5.61) and 6.26 (95% CI 3.84 to 10.2). This study shows that irrespective of renal status, the need for insulin in the setting of DM identifies a group with substantial risk of death or myocardial infarction at 1 year.

Published
2018

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