871 results on '"Timothy D Henry"'
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2. Impaired therapeutic efficacy of bone marrow cells from post-myocardial infarction patients in the TIME and LateTIME clinical trials.
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Xiaoyin Wang, Lourdes I Chacon, Ronak Derakhshandeh, Hilda J Rodriguez, Daniel D Han, Dmitry S Kostyushev, Timothy D Henry, Jay H Traverse, Lem Moyé, Robert D Simari, Doris A Taylor, and Matthew L Springer more...
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Medicine ,Science - Abstract
Implantation of bone marrow-derived cells (BMCs) into mouse hearts post-myocardial infarction (MI) limits cardiac functional decline. However, clinical trials of post-MI BMC therapy have yielded conflicting results. While most laboratory experiments use healthy BMC donor mice, clinical trials use post-MI autologous BMCs. Post-MI mouse BMCs are therapeutically impaired, due to inflammatory changes in BMC composition. Thus, therapeutic efficacy of the BMCs progressively worsens after MI but recovers as donor inflammatory response resolves. The availability of post-MI patient BM mononuclear cells (MNCs) from the TIME and LateTIME clinical trials enabled us to test if human post-MI MNCs undergo a similar period of impaired efficacy. We hypothesized that MNCs from TIME trial patients would be less therapeutic than healthy human donor MNCs when implanted into post-MI mouse hearts, and that therapeutic properties would be restored in MNCs from LateTIME trial patients. Post-MI SCID mice received MNCs from healthy donors, TIME patients, or LateTIME patients. Cardiac function improved considerably in the healthy donor group, but neither the TIME nor LateTIME group showed therapeutic effect. Conclusion: post-MI human MNCs lack therapeutic benefits possessed by healthy MNCs, which may partially explain why BMC clinical trials have been less successful than mouse studies. more...
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- 2020
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3. Enhanced External Counterpulsation Improves Dyspnea, Fatigue, and Functional Capacity in Patients with Long COVID
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Jessie Fox, Farhan Ali, Marielisa Lopez, Sachin A. Shah, Christian W. Schmidt, Odayme Quesada, Timothy D. Henry, and Monica Verduzco-Gutierrez
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long COVID ,PASC ,enhanced external counterpulsation ,EECP ,Specialties of internal medicine ,RC581-951 - Abstract
Approximately 31% of patients previously infected with SARS-CoV-2 are living with symptoms of long COVID in the United States. Long COVID significantly reduces quality of life and increases morbidity and disability; however, treatment options are limited. Enhanced External Counterpulsation (EECP) is an FDA-approved, non-invasive treatment for the management of cardiovascular symptoms with a mechanism of action which stimulates pathways that induce endothelial homeostasis, improving microvascular function, inflammation, and immune regulation, thereby potentially targeting the underlying etiology of long COVID. We recently reported that EECP improved symptoms in 231 patients with long COVID. Previous studies assessing the effects of EECP for long COVID have lacked a control group. As such, this analysis is the first comparing outcomes in patients with long COVID undergoing EECP (n = 33) to a non-treated group (control, n = 33). The patients were matched for baseline characteristics, and all patients completed patient-reported outcome assessments, including PROMIS Fatigue, the Duke Activity Status Index (DASI), and the Rose Dyspnea Scale (RDS), two times within a specified time interval. When comparing the average change from baseline in both groups, the EECP-treated patients’ improvement was significantly greater than the improvement in the control group across all measured endpoints, including PROMIS Fatigue (−15.0 ± 8.9 vs. −2.8 ± 5.9, p < 0.001) and DASI (+17.8 (11.8, 26.8) vs. +1.8 (−3.5, 5.5), p < 0.001), and there was an improvement of ≥1 in the RDS class (75.8% vs. 33.3%, p < 0.001). This study’s limitations include the small sample size and lack of information regarding concurrent treatments or interventions in the non-treated group; however, these preliminary data support EECP as a potential low-risk treatment option for patients with long COVID. more...
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- 2024
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4. SCAI Expert Consensus Statement on the Management of Patients With STEMI Referred for Primary PCI
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Jacqueline E. Tamis-Holland, MD, FSCAI (Chair), J. Dawn Abbott, MD, FSCAI, Karim Al-Azizi, MD, FSCAI, Nitin Barman, MD, Anna E. Bortnick, MD, PhD, MSc, FSCAI, Mauricio G. Cohen, MD, FSCAI, Payam Dehghani, MD, FSCAI, Timothy D. Henry, MD, MSCAI, Faisal Latif, MD, FSCAI, Mohammad Madjid, MD, FSCAI, Celina M. Yong, MD, MBA, MSc, FSCAI, and Yader Sandoval, MD, FSCAI (Co-Chair) more...
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intravascular imaging ,mechanical circulatory support ,microvascular obstruction ,no reflow ,PCI ,STEMI ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ST-elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality in the United States. Timely reperfusion with primary percutaneous coronary intervention is associated with improved outcomes. The Society for Cardiovascular Angiography & Interventions puts forth this expert consensus document regarding best practices for cardiac catheterization laboratory team readiness, arterial access with an algorithm to help determine proper arterial access in STEMI, and diagnostic angiography. This consensus statement highlights the strengths and limitations of various diagnostic and therapeutic interventions to access and treat a patient with STEMI in the catheterization laboratory, reviews different options to manage large thrombus burden during STEMI, and reviews the management of STEMI across the spectrum of various anatomical and clinical circumstances. more...
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- 2024
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5. The Revolution of STEMI Care: A Story of Resilience, Persistence, and Success
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Paul Bamford, MBChB, Timothy D. Henry, MD, William W. O’Neill, MD, and Cindy L. Grines, MD
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interventional cardiology ,percutaneous transluminal coronary angioplasty ,primary percutaneous coronary intervention ,ST-elevation myocardial infarction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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6. Comments on: Safety and efficacy of aminophylline in the prevention of bradyarrhythmia during coronary atherectomy
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Robert F. Riley and Timothy D. Henry
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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7. Evaluation of coronary microvascular dysfunction using magnetocardiography: A new application to an old technology
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Namrita Ashokprabhu, Khaled Ziada, Edouard Daher, Leslie Cho, Christian W. Schmidt, Yulith Roca, Cassady Palmer, Sukhleen Kaur, Timothy D. Henry, Carl J. Pepine, and Odayme Quesada
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Magnetocardiography ,Coronary flow reserve ,Ischemia ,Coronary microvascular dysfunction ,Angina and non-obstructive coronary artery disease ,ANOCA ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: In patients with angina and non-obstructive coronary artery disease (ANOCA), diagnosis of coronary microvascular dysfunction (CMD) remains an unmet need. Magnetocardiography (MCG), is a rest-based, non-invasive scan that can detect weak electrophysiological changes that occur at the early phase of ischemia. Objective: This study assessed the ability of MCG to detect CMD in ANOCA patients as compared to reference standard, invasive coronary flow reserve (CFR). Methods: Patients with ANOCA and invasive coronary physiologic assessment using intracoronary flow measurements with Doppler and thermodilution methods were enrolled. CMD was defined dichotomously as an invasive CFR more...
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- 2024
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8. Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients
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Jacob C. Jentzer, Sean Van Diepen, Parag C. Patel, Timothy D. Henry, David A. Morrow, David A. Baran, and Kianoush B. Kashani
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cardiogenic ,heart failure ,mortality ,myocardial infarction ,shock ,cardiac intensive care unit ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background One‐time assessment of the Society for Cardiovascular Angiography and Interventions (SCAI) shock classification robustly predicts mortality in the cardiac intensive care unit (CICU). We sought to determine whether serial SCAI shock classification could improve risk stratification. Methods and Results Unique admissions to a single academic level 1 CICU from 2015 to 2018 were included in this retrospective cohort study. Electronic health record data were used to assign the SCAI shock stage during 4‐hour blocks of the first 24 hours of CICU admission. Shock was defined as hypoperfusion (SCAI shock stage C, D, or E). In‐hospital death was evaluated using logistic regression. Among 2918 unique CICU patients, 1537 (52.7%) met criteria for shock during ≥1 block, and 266 (9.1%) died in the hospital. The SCAI shock stage on admission was: A, 37.6%; B, 31.5%; C, 25.9%; D, 1.8%; and E, 3.3%. Patients who met SCAI criteria for shock on admission (first 4 hours) and those with worsening SCAI shock stage after admission were at higher risk for in‐hospital death. Each higher admission (adjusted odds ratio, 1.36 [95% CI, 1.18–1.56]; area under the receiver operating characteristic curve, 0.70), maximum (adjusted odds ratio, 1.59 [95% CI, 1.37–1.85]; area under the receiver operating characteristic curve, 0.73) and mean (adjusted odds ratio, 2.42 [95% CI, 1.99–2.95]; area under the receiver operating characteristic curve, 0.78) SCAI shock stage was incrementally associated with a higher in‐hospital mortality rate. Discrimination was highest for the mean SCAI shock stage (P more...
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- 2023
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9. Association of triglyceride levels with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction
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Mehmet Yildiz, Michael D. Miedema, Avinash Murthy, Timothy D. Henry, Seth Bergstedt, Brynn K. Okeson, Christian W. Schmidt, Lucas Volpenhein, Santiago Garcia, Scott W. Sharkey, and Frank V. Aguirre
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STEMI ,Triglyceride ,MACE ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Although there is an established association between elevated triglyceride (eTG, ≥175 mg/dl) levels and adverse cardiovascular events, some studies have suggested that eTG levels may be linked to neutral or even improved clinical outcomes, particularly among patients with acute myocardial infarction. However, these studies had certain limitations, including small sample sizes, heterogeneous study populations, and inadequate statistical adjustments. To address these limitations, we conducted an analysis of 5347 patients with ST-segment elevation myocardial infarction (STEMI) between March 2003 and December 2020, using a prospective registry-based cohort from two large, regional STEMI centers. We used a triglyceride level of 175 mg/dl as the cutoff point for eTG levels. Of the study participants, 24.5% (n = 1312) had eTG levels. These patients were more likely to be younger, male, and have a higher number of cardiovascular risk factors compared to those with low TG levels. Despite these unfavorable cardiovascular risk profiles, patients with eTG levels had lower unadjusted risks of 1-year major adverse cardiac events (MACE) -a composite of myocardial infarction, stroke, and death- than those with low TG levels (8.8% vs. 11%, p = 0.034). However, after adjusting for certain clinical factors and lipid profile, eTG levels were not associated with a lower 1-year MACE (aHR: 1.10 (0.71–1.70), p = 0.7). In conclusion, a quarter of STEMI patients had eTG levels and these patients had comparable long-term cardiovascular outcomes compared to those with low TG levels after controlling for clinical factors and lipid profile. more...
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- 2023
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10. INOCA/ANOCA: Mechanisms and novel treatments
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Namrita D. Ashokprabhu, Odayme Quesada, Yulith Roca Alvarez, and Timothy D. Henry
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INOCA ,ANOCA ,Coronary microvascular dysfunction ,Coronary functional angiography ,Coronary sinus reducer ,CD34+ stem cell therapy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Angina or ischemia with no obstructive coronary disease (ANOCA/INOCA) is a common but under-treated condition due to poorly understood pathophysiologic mechanisms, limited diagnostic tools, and lack of proven targeted therapy. Coronary microvascular dysfunction (CMD) occurs when the microvasculature inadequately perfuses the myocardium under stress, or at rest in the case of microvascular spasm resulting in ANOCA/INOCA. Coronary functional angiography (CFA) measures endothelial independent microvascular dysfunction (coronary flow reduction more...
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- 2023
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11. STEMI care 2021: Addressing the knowledge gaps
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Mehmet Yildiz, Spencer R. Wade, and Timothy D. Henry
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ST-segment elevation myocardial infarction ,Regional systems ,Cardiogenic shock ,Out-of-hospital cardiac arrest ,Covid-19 ,Cangrelor ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Tremendous progress has been made in the treatment of ST-segment elevation myocardial infarction (STEMI), the most severe and time-sensitive acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion, which has stimulated the development of regional STEMI systems of care with standardized protocols designed to optimize care. However, challenges remain for patients with cardiogenic shock, out-of-hospital cardiac arrest, an expected delay to reperfusion (>120 min), in-hospital STEMI, and more recently, those with Covid-19 infection. Ultimately, the goal is to provide timely reperfusion with primary PCI coupled with the optimal antiplatelet and anticoagulant therapies. We review the challenges and provide insights into the remaining knowledge gaps for contemporary STEMI care. more...
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- 2021
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12. Feasibility of a voice-enabled automated platform for medical data collection: CardioCube.
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Tomasz Jadczyk, Oskar Kiwic, Raj M. Khandwalla, Krzysztof Grabowski, Slawomir Rudawski, Przemyslaw Magaczewski, Hafidha Benyahia, Wojciech Wojakowski, and Timothy D. Henry
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- 2019
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13. First-in-Man Study of a Cardiac Extracellular Matrix Hydrogel in Early and Late Myocardial Infarction Patients
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Jay H. Traverse, MD, Timothy D. Henry, MD, Nabil Dib, MD, Amit N. Patel, MD, Carl Pepine, Gary L. Schaer, MD, Jessica A. DeQuach, PhD, Adam M. Kinsey, PhD, Paul Chamberlin, MD, and Karen L. Christman, PhD more...
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Summary: This study evaluated the safety and feasibility of transendocardial injections of VentriGel, a cardiac extracellular matrix hydrogel, in early and late post–myocardial infarction (MI) patients with left ventricular (LV) dysfunction. VentriGel was delivered in 15 patients with moderate LV dysfunction (25% ≤ LV ejection fraction ≤ 45%) who were between 60 days to 3 years post-MI and were revascularized by percutaneous coronary intervention. The primary endpoints were incidence of adverse events and abnormal clinical laboratory results. This first-in-man study established the safety and feasibility of delivering VentriGel in post-MI patients, thus warranting further evaluation in larger, randomized clinical trials. Key Words: biomaterial, catheter, heart failure, injectable, myocardial infarction more...
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- 2019
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14. Interaction of COVID-19 With Common Cardiovascular Disorders
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Peter K. Boulos, Scott V. Freeman, Timothy D. Henry, Ehtisham Mahmud, and John C. Messenger
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Physiology ,Cardiology and Cardiovascular Medicine - Abstract
The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic. more...
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- 2023
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15. Microvascular obstruction identifies a subgroup of patients who benefit from stem cell therapy following ST-elevation myocardial infarction
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Sarah J. Davidson, Jerome Roncalli, Daniel Surder, Roberto Corti, Atul R. Chugh, Phillip C. Yang, Timothy D. Henry, Larissa Stanberry, Patricia Lemarchand, Jeau-Paul Beregi, and Jay H. Traverse
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Cardiology and Cardiovascular Medicine - Published
- 2023
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16. Impact of COVID-19 on Acute Myocardial Infarction Care
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Raviteja R, Guddeti, Mehmet, Yildiz, Keshav R, Nayak, M Chadi, Alraies, Laura, Davidson, Timothy D, Henry, and Santiago, Garcia
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Percutaneous Coronary Intervention ,Communicable Disease Control ,Myocardial Infarction ,COVID-19 ,Humans ,ST Elevation Myocardial Infarction ,General Medicine ,Cardiology and Cardiovascular Medicine ,Pandemics - Abstract
The global health crisis caused by the COVID-19 pandemic has evolved rapidly to overburden health care organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes and percutaneous coronary intervention. The reasons for such abrupt changes in health care delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted during the pandemic. This review discusses the impact of COVID-19 on important aspects of acute MI care. more...
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- 2023
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17. A Review of Heart Failure in Patients with COVID-19
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Hanad Bashir, Mehmet Yildiz, John Cafardi, Ankit Bhatia, Santiago Garcia, Timothy D. Henry, and Eugene S. Chung
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
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18. Randomized Trial of Targeted Transendocardial Mesenchymal Precursor Cell Therapy in Patients With Heart Failure
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Emerson C. Perin, Kenneth M. Borow, Timothy D. Henry, Farrell O. Mendelsohn, Leslie W. Miller, Elizabeth Swiggum, Eric D. Adler, David H. Chang, R. David Fish, Alain Bouchard, Margaret Jenkins, Alex Yaroshinsky, Jack Hayes, Olga Rutman, Christopher W. James, Eric Rose, Silviu Itescu, and Barry Greenberg more...
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Cardiology and Cardiovascular Medicine - Published
- 2023
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19. Extracorporeal Membrane Oxygenation for Cardiogenic Shock: When to Open the Parachute?
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Timothy D. Henry, Demetri Yannopoulos, and Sean van Diepen
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
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20. Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction
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Raviteja R, Guddeti, Cristina, Sanina, Rajiv, Jauhar, Timothy D, Henry, Payam, Dehghani, Ross, Garberich, Christian W, Schmidt, Keshav R, Nayak, Jay S, Shavadia, Akshay, Bagai, Chadi, Alraies, Aditya, Mehra, Rodrigo, Bagur, Cindy, Grines, Avneet, Singh, Rajan A G, Patel, Wah Wah, Htun, Nima, Ghasemzadeh, Laura, Davidson, Deepak, Acharya, Ameer, Kabour, Abdul Moiz, Hafiz, Shy, Amlani, Hal S, Wasserman, Timothy, Smith, Navin K, Kapur, and Santiago, Garcia more...
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Cardiology and Cardiovascular Medicine - Abstract
ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS. more...
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- 2023
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21. Cardiovascular Effects of COVID-19
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Timothy D. Henry, Santiago Garcia, and Eduardo Bossone
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
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22. Eligibility of out-of-hospital cardiac arrest patients for extracorporeal cardiopulmonary resuscitation in the United States: A geographic information system model
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Adam L. Gottula, Christopher R. Shaw, Kari L. Gorder, Bennett H. Lane, Jennifer Latessa, Man Qi, Amy Koshoffer, Rabab Al-Araji, Wesley Young, Jordan Bonomo, James R. Langabeer, Demetris Yannopoulos, Timothy D. Henry, Cindy H. Hsu, and Justin L. Benoit more...
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Emergency Medicine ,Emergency Nursing ,Cardiology and Cardiovascular Medicine - Abstract
Recent evidence suggest that extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers.We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. The combined model was used to estimate the total number of ECPR candidates.There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were deemed eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model.Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies. more...
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- 2022
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23. Revascularization and long‐term outcomes in high‐acuity spontaneous coronary artery dissection
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Christina Thaler, Dawn R. Witt, Timothy D. Henry, Elizabeth Z. Grey, Courtney J. Baechler, Opema Lohese, Brynn K. Okeson, Christian W. Schmidt, and Scott W. Sharkey
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Spontaneous coronary artery dissection (SCAD) is often treated conservatively due to revascularization risks. Yet, an important number of SCAD patients have high acuity characteristics necessitating revascularization, with uncertain long-term outcomes.Document revascularization utilization and long-term outcomes in high acuity SCAD.Prospective/retrospective analysis of consecutive patients with acute myocardial infarction (AMI) due to first SCAD event presenting directly to the Minneapolis Heart Institute 2002-2021, median follow-up 3.8 years.Among 139 patients (age 49 ± 12 years, 96% female), revascularization was performed in 60 (43%), utilizing percutaneous coronary intervention (PCI) (n = 56, successful in 80%) or coronary artery bypass graft (n = 4). In the entire cohort, 90 (65%) unique patients had one or more high acuity characteristic: ST-elevation (38%), proximal dissection (38%), cardiogenic shock (6.5%), cardiac arrest (9.4%), left main dissection (6.5%), peripartum dissection (7.2%). High acuity patients accounted for 51 of 60 (85%) revascularizations. Revascularization rates were: ST-elevation (60%), proximal dissection (62%), cardiogenic shock (89%), cardiac arrest (62%), left main dissection (100%), peripartum dissection (70%). Survival was 97% (revascularized) vs 100% (nonrevascularized); p = 0.2. Adverse outcomes (revascularized vs. nonrevascularized) included recurrent AMI:16.7% versus 8.9%; p = 0.2, SCAD recurrence: 13.3% versus 6.3%; p = 0.1, stroke: 5% versus 2.5%; p = 0.44, implantable cardioverter-defibrillator: 6.7% versus 6.3%; p 0.9. Reintervention was necessary in 21% of PCI-treated patients.High-acuity characteristics were present in nearly two-thirds of this SCAD cohort; the vast majority of revascularizations were performed in high-acuity patients. Despite high acuity, long-term survival was favorable in revascularized patients. more...
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- 2022
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24. Contemporary Management of Refractory Angina
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Rebekah, Lantz, Odayme, Quesada, Georgia, Mattingly, and Timothy D, Henry
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Risk Factors ,Myocardial Ischemia ,Quality of Life ,Humans ,Coronary Artery Disease ,Cardiology and Cardiovascular Medicine ,Article ,Angina Pectoris - Abstract
Refractory angina is defined as chest pain caused by coronary ischemia in patients on maximal medical therapy and not amenable to revascularization despite advanced coronary artery disease. The long term prognosis has improved with optimal medical therapy including risk factor modification. Still, patients are left with major impairment in quality of life and have high resource utilization with limited treatment options. We review the novel invasive and non-invasive therapies under investigation for refractory angina. more...
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- 2022
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25. Management Principles for the Cardiac Catheterization Laboratory During the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Pandemic
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Keshav R, Nayak, Ryan C, Maves, and Timothy D, Henry
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Cardiac Catheterization ,SARS-CoV-2 ,Myocardial Infarction ,COVID-19 ,Humans ,Cardiology and Cardiovascular Medicine ,Pandemics - Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a highly contagious pathogen resulting in the 2019 coronavirus disease (COVID-19) pandemic with direct impact on cardiac catheterization laboratory (CCL) operations. Initially, major challenges in limiting the spread of aerosolized pathogens existed until protocols were implemented to limit infectivity to staff and patients. COVID-19 increases the risk of myocardial infarctions and cardiogenic shock requiring acute management in the CCL. In this review, we specify best practices in the CCL for the management of infected patients in the preprocedure, intraprocedure, and postprocedure environments harmonizing available evidence, recommendations from international heart associations, and consensus opinion. more...
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- 2022
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26. QFR Facilitated Functional Lesion Assessment to Guide Revascularization
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Timothy D. Henry and Dean J. Kereiakes
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Cardiology and Cardiovascular Medicine - Published
- 2022
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27. Time Course of Microvascular Stunning in ST-Segment–Elevation Myocardial Infarction
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Timothy D. Henry, Odayme Quesada, and Robert F. Wilson
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Cardiology and Cardiovascular Medicine - Published
- 2022
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28. Safety of Provocative Testing With Intracoronary Acetylcholine and Implications for Standard Protocols
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Tatsunori Takahashi, Bruce A. Samuels, Weijia Li, Manish A. Parikh, Janet Wei, Jeffery W. Moses, William F. Fearon, Timothy D. Henry, Jennifer A. Tremmel, and Yuhei Kobayashi
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Spasm ,Meta-Analysis as Topic ,Ventricular Fibrillation ,Coronary Vasospasm ,Humans ,Coronary Angiography ,Cardiology and Cardiovascular Medicine ,Coronary Vessels ,Acetylcholine - Abstract
Heterogeneity in diagnostic criteria and provocation protocols has posed challenges in understanding the safety of coronary provocation testing with intracoronary acetylcholine (ACh) for the contemporary diagnosis of epicardial and microvascular spasm.We examined the safety of testing and subgroup differences in procedural risks based on ethnicity, diagnostic criteria, and provocation protocols.PubMed and Embase were searched in November 2021 to identify original articles reporting procedural complications associated with intracoronary ACh administration. The primary outcome was the pooled estimate of the incidence of major complications including death, myocardial infarction, ventricular tachycardia/fibrillation, and shock.A total of 16 studies with 12,585 patients were included in the meta-analysis. The overall pooled estimate of the incidence of major complications was 0.5% (95% CI: 0.0%-1.3%) without any reports of death. Exploratory subgroup analyses revealed that the pooled incidence of major complications was significantly higher in the studies that followed the contemporary diagnosis criteria for epicardial spasm defined as ≥90% diameter reduction (1.0%; 95% CI: 0.3%-2.0%) but significantly lower in Western populations (0.0%; 95% CI: 0.0%-0.45%). The rate of positive epicardial spasm and the incidence of major complications were similar between provocation protocols using the maximum ACh doses of 100 μg and 200 μg.Intracoronary ACh administration for the contemporary diagnosis of epicardial and microvascular spasm is a safe procedure. Moreover, excellent safety records are observed in Western populations primarily presenting with myocardial ischemia and/or infarction with nonobstructive coronary arteries. This study will help standardize ACh testing to improve clinical diagnosis and ensure procedural safety. more...
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- 2022
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29. Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19
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Santiago Garcia, Payam Dehghani, Larissa Stanberry, Cindy Grines, Rajan A.G. Patel, Keshav R. Nayak, Avneet Singh, Wah Wah Htun, Ameer Kabour, Nima Ghasemzadeh, Cristina Sanina, Joseph Aragon, M. Chadi Alraies, Catherine Benziger, Brynn Okeson, Ross Garberich, Frederick G. Welt, Laura Davidson, Abdul Moiz Hafiz, Deepak Acharya, Jay Stone, Aditya Mehra, Shy Amlani, Ehtisham Mahmud, Jay Giri, Mehmet Yildiz, and Timothy D. Henry more...
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Percutaneous Coronary Intervention ,COVID-19 ,Humans ,ST Elevation Myocardial Infarction ,Hospital Mortality ,Prospective Studies ,Cardiology and Cardiovascular Medicine - Abstract
We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic.The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic.The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021).A total of 586 COVID-19-positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients' characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009).Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic. more...
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- 2022
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30. Implications of the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Chest Pain Guideline for Cardiovascular Imaging
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Ron Blankstein, Leslee J. Shaw, Martha Gulati, Michael K. Atalay, Jeroen Bax, Dennis A. Calnon, Christopher K. Dyke, Maros Ferencik, Jonathan F. Heitner, Timothy D. Henry, Judy Hung, Juhani Knuuti, Jonathan R. Lindner, Lawrence M. Phillips, Subha V. Raman, Sunil V. Rao, Frank J. Rybicki, Antti Saraste, Raymond F. Stainback, Randall C. Thompson, Eric Williamson, Koen Nieman, Jennifer A. Tremmel, Pamela K. Woodard, Marcelo F. Di Carli, and Y.S. Chandrashekhar more...
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2022
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31. STEMI: Considerations for Left Main Culprit Lesions
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Ameera Ahmed, Frank V. Aguirre, Jenny Chambers, Scott W. Sharkey, Mark A. Tannenbaum, Mehmet Yildiz, Ross Garberich, Santiago Garcia, and Timothy D. Henry
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Cardiology and Cardiovascular Medicine - Published
- 2022
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32. Characteristics and Long-term Mortality in Patients with ST-Segment Elevation Myocardial Infarction with Non-Obstructive Coronary Arteries (STE-MINOCA): A High Risk Cohort
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Odayme Quesada, Mehmet Yildiz, Timothy D. Henry, Brynn K. Okeson, Jenny Chambers, Ananya Shah, Larissa Stanberry, Lucas Volpenhein, Dalia Aziz, Rebekah Lantz, Cassady Palmer, Justin Ugwu, Muhammad J. Ahsan, Ross F. Garberich, Heather S. Rohm, Frank V. Aguirre, Santiago Garcia, and Scott W. Sharkey more...
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Article - Abstract
BackgroundThe prognosis of ST-segment elevation myocardial infarction with non-obstructive coronaries (STE-MINOCA) is largely unknown.MethodsThe objective of this study is to evaluate the prevalence, characteristics, and 5-year mortality of patients with STE-MINOCA compared to STEMI with coronary artery obstruction (STEMI-Obstruction) using a multicenter cohort of consecutive STEMI patients at 3 regional Midwest STEMI programs from 2003 to 2020. STE-MINOCA was defined based on (1) coronary stenosis < 60% by visual estimation, (2) ischemia with elevated troponin, and (3) no alternative diagnosis. STE-MINOCA was further classified based on American Heart Association (AHA) definition as AHA STE-MINOCA and AHA STE-MINOCA Mimicker.Results8,566 STEMI patients, including 420 (4.9%) STE-MINOCA (26.9% AHA STE-MINOCA and 73.1% AHA STE-MINOCA Mimicker) were followed for a median of 7.1 years. Compared to STEMI-Obstruction, STE-MINOCA were younger, more often female, had fewer cardiovascular risk factors, and were less likely to be discharged on cardiac medications. At five years, mortality was higher in STE-MINOCA compared with STEMI-Obstruction (18% vs. 15%, p=0.033). In propensity score-matched analysis, STE-MINOCA had a 1.4-fold (95% CI: 1.04-1.89, p=0.028) higher risk of 5-year all-cause mortality compared with STEMI-Obstruction. Furthermore, 5-year mortality risk was significantly higher in AHA STE-MINOCA Mimicker (19% vs. 15%, p=0.043) but similar in AHA STE-MINOCA (17% vs. 15%, p=0.42) compared with STEMI-Obstruction.ConclusionsIn this large multicenter STEMI cohort, nearly 5% of patients presented with STE-MINOCA. At five years, mortality approached 20% among patients with STE-MINOCA. Despite the lower risk profile, STE-MINOCA patients were at 40% higher risk of 5-year all-cause mortality compared with STEMI-Obstruction. Additionally, 5-year all-cause mortality risk was higher in AHA STE-MINOCA Mimicker but similar in AHA STE-MINOCA compared to STEMI-Obstruction. more...
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- 2023
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33. Epicardial delivery of XC001 gene therapy for refractory angina coronary treatment (The EXACT Trial): Rationale, design, and clinical considerations
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Rickey R. Reinhardt, Thomas J. Povsic, Nahush A. Mokadam, Geoffrey A. Answini, Carl J. Pepine, Jay H. Traverse, Timothy D. Henry, Ronald G. Crystal, Howard C. Dittrich, Todd K. Rosengart, and E. Magnus Ohman more...
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Male ,medicine.medical_specialty ,Maximum Tolerated Dose ,medicine.medical_treatment ,Genetic Vectors ,Revascularization ,Adenoviridae ,Angina Pectoris ,Angina ,Coronary artery disease ,Clinical Trials, Phase II as Topic ,Drug Delivery Systems ,Internal medicine ,medicine ,Humans ,Adverse effect ,Aged ,Exercise Tolerance ,Vascular Endothelial Growth Factors ,business.industry ,Coronary flow reserve ,Cardiovascular Agents ,Genetic Therapy ,Canadian Cardiovascular Society ,medicine.disease ,Clinical trial ,Treatment Outcome ,Tolerability ,Cardiology ,Angiogenesis Inducing Agents ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pericardium - Abstract
Background Patients with refractory angina (RA) have poor quality of life and new therapies are needed. XC001 is a novel adenoviral vector expressing multiple isoforms of vascular endothelial growth factor (VEGF) promoting an enhanced local angiogenic effect. Methods The E picardial Delivery of X C001 Gene Therapy for Refractory A ngina C oronary T reatment (EXACT) trial is a 6-month (with 6-month extension) phase 1/2, first-in-human, multicenter, open-label, single-arm, dose-escalation study to evaluate the safety, tolerability, and preliminary efficacy of XC001 in patients with RA. The trial will enroll 33 patients in an initial (n = 12) ascending dose-escalation phase (1 × 109, 1 × 1010, 4 × 1010, and 1 × 1011 viral particles), followed by phase 2 (n = 21) assessing the highest tolerated dose. Patients must have stable Canadian Cardiovascular Society (CCS) class II–IV angina on maximally tolerated medical therapy without options for conventional revascularization, demonstrable ischemia on stress testing, and angina limiting exercise tolerance. XC001 will be delivered directly to ischemic myocardium via surgical transthoracic epi c ardial access. The primary outcome is safety via adverse event monitoring through 6 months. Efficacy assessments include difference from baseline to month 6 in time to 1 mm of ST segment depression, time to angina, and total exercise duration; myocardial blood flow at rest, and stress and coronary flow reserve by positron emission tomography; quality of life; CCS functional class; and angina frequency. Conclusions The EXACT trial will determine whether direct intramyocardial administration of XC001 in patients with RA is safe and evaluate its effect on exercise tolerance, myocardial perfusion, angina and physical activity, informing future clinical investigation. Clinical trial registration NCT04125732 more...
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- 2021
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34. On-Treatment Platelet Reactivity and Ischemic Outcomes in Patients With Diabetes Mellitus: Two-Year Results From ADAPT-DES
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Bahira Shahim, Björn Redfors, Thomas D. Stuckey, Mengdan Liu, Zhipeng Zhou, Bernhard Witzenbichler, Giora Weisz, Michael J. Rinaldi, Franz‐Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Bruce R. Brodie, Iva Srdanovic, Mahesh V. Madhavan, Ernest L. Mazzaferri, Roxana Mehran, Ori Ben‐Yehuda, Ajay J. Kirtane, and Gregg W. Stone more...
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Cardiology and Cardiovascular Medicine - Abstract
Background Diabetes mellitus and high platelet reactivity (HPR) on clopidogrel are both associated with increased risk of ischemic events after percutaneous coronary intervention, but whether the HPR‐associated risk of adverse ischemic events differs by diabetes mellitus status is unknown. Methods and Results ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents) was a prospective, multicenter registry of patients treated with coronary drug‐eluting stents. HPR was defined as P2Y12 reaction units >208 by the VerifyNow point‐of‐care assay. Cox multivariable analysis was used to assess whether HPR‐associated risk of major adverse cardiac events (MACE; cardiac death, myocardial infarction, or stent thrombosis) varied for patients with insulin‐treated diabetes mellitus (ITDM), non–ITDM, and no diabetes mellitus. Diabetes mellitus and HPR were included in an interaction analysis. Of 8582 patients enrolled, 2429 (28.3%) had diabetes mellitus, of whom 998 (41.1%) had ITDM. Mean P2Y12 reaction units were higher in patients with diabetes mellitus versus without diabetes mellitus, and HPR was more frequent in patients with diabetes mellitus. HPR was associated with consistently increased 2‐year rates of MACE in patients with and without diabetes mellitus ( P interaction =0.36). A significant interaction was present between HPR and non–insulin‐treated diabetes mellitus versus ITDM for 2‐year MACE (adjusted hazard ratio [HR] for non–ITDM, 2.28 [95% CI, 1.39–3.73] versus adjusted HR for ITDM, 1.02 [95% CI, 0.70–1.50]; P interaction =0.01). Conclusions HPR was more common in patients with diabetes mellitus and was associated with an increased risk of MACE in both patients with and without diabetes mellitus. In patients with diabetes mellitus, a more pronounced effect of HPR on MACE was present in lower‐risk non–ITDM patients than in higher‐risk patients with ITDM. Registration URL: https://clinicaltrials.gov/ct2/show/NCT00638794 ; Unique identifier: NCT00638794. ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents). more...
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- 2022
35. 761 PRASUGREL OR CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROMES AT DIFFERENT THROMBOTIC RISK: RESULTS FROM THE PROMETHEUS STUDY
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Mauro Chiarito, Davide Cao, Samantha Sartori, Zhongjie Zhang, Birgit Vogel, Johny Nicholas, Carlo Andrea Pivato, Alessandro Spirito, Annerieke Tavenier, Mark Effron, Giulio G Stefanini, Usman Baber, Samir Kapadia, Sunil Rao, Timothy D Henry, Stuart Pocock, George Dangas, Annapoorna Kini, and Roxana Mehran more...
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Cardiology and Cardiovascular Medicine - Abstract
Background Potent P2Y12 inhibitors are recommended in patients with acute coronary syndrome (ACS), although the optimal antithrombotic strategy should be tailored based on patients thrombotic and hemorrhagic risk profile. We evaluated if the benefits associated with prasugrel vs. clopidogrel in ACS patients undergoing percutaneous coronary intervention (PCI) are similar in patients with different thrombotic risk profiles. Methods PROMETHEUS was a multicenter observational study comparing prasugrel vs. clopidogrel in ACS patients undergoing PCI. Patients were defined at high thrombotic risk if presenting with a clinical and a procedural risk feature. The primary endpoint was major adverse cardiac events (MACE), composite of death, myocardial infarction, stroke, or unplanned revascularization. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated using propensity-stratified analysis and with multivariable Cox regression. Results Among 16,065 patients, 4,293 were defined at high and 11,772 at low-to-moderate thrombotic risk. Patients receiving prasugrel had less comorbidities and risk factors than those treated with clopidogrel, both in the high and low-to-moderate thrombotic risk strata. High thrombotic risk patients had increased rates of ischemic and bleeding events at 90-day and 1-year follow-up. Patients treated with prasugrel had a lower adjusted 1-year risk of MACE (HR 0.86, 95% CI 0.77-0.96), irrespective of their thrombotic risk (pinteraction =0.32). Stratifying the study population by number of risk factors there was a significant interaction (pinteraction =0.026) for a greater reduction in MACE with prasugrel among patients with ≤1 thrombotic risk factor. The risk of clinically significant bleeding was similar in patients treated with prasugrel and clopidogrel. Conclusions Patients with ACS at high thrombotic risk who undergo PCI are at increased risk of adverse events at 1 year. Prasugrel, mainly reserved to patients with less comorbidities, reduced the risk of ischemic events both in patients at high and low-to-moderate thrombotic risk as compared with clopidogrel. more...
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- 2022
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36. Personalized vascular healthcare: insights from a large international survey
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Nick E J West, Maneesh Juneja, Natalia Pinilla, Koen R De Loose, Timothy D Henry, Connie S Baumgard, and Olga Kraineva
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Cardiology and Cardiovascular Medicine - Abstract
Fragmentation of healthcare systems through limited cross-speciality communication and intermittent, intervention-based care, without insight into follow-up and compliance, results in poor patient experiences and potentially contributes to suboptimal outcomes. Data-driven tools and novel technologies have the capability to address these shortcomings, but insights from all stakeholders in the care continuum remain lacking. A structured online questionnaire was given to respondents (n = 1432) in nine global geographies to investigate attitudes to the use of data and novel technologies in the management of vascular disease. Patients with coronary or peripheral artery disease (n = 961), physicians responsible for their care (n = 345), and administrators/healthcare leaders with responsibility for commissioning/procuring cardiovascular services (n = 126) were included. Narrative themes arising from the survey included patients’ desire for more personalized healthcare, shared decision-making, and improved communication. Patients, administrators, and physicians perceived and experienced deficiencies in continuity of care, and all acknowledged the potential for data-driven techniques and novel technologies to address some of these shortcomings. Further, physicians and administrators saw the ‘upstream’ segment of the care journey—before diagnosis, at point of diagnosis, and when determining treatment—as key to enabling tangible improvements in patient experience and outcomes. Finally, despite acceptance that data sharing is critical to the success of such interventions, there remains persistent issues related to trust and transparency. The current fragmented care continuum could be improved and streamlined through the adoption of advanced data analytics and novel technologies, including diagnostic and monitoring techniques. Such an approach could enable the refocusing of healthcare from intermittent contacts and intervention-only focus to a more holistic patient view. more...
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- 2022
37. Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late-presenting STEMI
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Anna C. Gonzalez Griffin, Mehmet Yildiz, Steven Bradley, Jenna E. Smith, Santiago Garcia, Christian W. Schmidt, Ross Garberich, Evan Walser‐Kuntz, Jay Traverse, James G. Jollis, Scott W. Sharkey, and Timothy D. Henry more...
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
To assess the characteristics and prognosis of ST-elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States.Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late-presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era.Using a two-center registry-based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time:3, 3-6, 6-12, and 12-24 h (late presenters).Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid-19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door-to-balloon time (82, 109, 107, and 117 min; p for trend 0.001). In-hospital and 1-year death risks were comparable between late and earlier presenters.Despite the unfavorable risk profile and longer door-to-balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset. more...
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- 2022
38. Does the Effectiveness of a Medicine Copay Voucher Vary by Baseline Medication Out-Of-Pocket Expenses? Insights From ARTEMIS
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Jennifer A. Rymer, Lisa A. Kaltenbach, Eric D. Peterson, David J. Cohen, Gregg C. Fonarow, Niteesh K. Choudhry, Timothy D. Henry, Christopher P. Cannon, and Tracy Y. Wang
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Treatment Outcome ,Myocardial Infarction ,Purinergic P2Y Receptor Antagonists ,Humans ,Health Expenditures ,Cardiology and Cardiovascular Medicine ,Medication Adherence - Abstract
Background Persistence to P2Y12 inhibitors after myocardial infarction (MI) remains low. Out‐of‐pocket cost is cited as a factor affecting medication compliance. We examined whether a copayment intervention affected 1‐year persistence to P2Y12 inhibitors and clinical outcomes. Methods and Results In an analysis of ARTEMIS (Affordability and Real‐World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study), patients with MI discharged on a P2Y12 inhibitor were stratified by baseline out‐of‐pocket medication burden: low ($0–$49 per month), intermediate ($50–$149 per month), and high (≥$150 per month). The impact of the voucher intervention on 1‐year P2Y12 inhibitor persistence was examined using a logistic regression model with generalized estimating equations. We assessed the rates of major adverse cardiovascular events among the groups using a Kaplan–Meier estimator. Among 7351 MI‐treated patients at 282 hospitals, 54.2% patients were in the low copay group, 32.0% in the middle copay group, and 13.8% in the high copay group. Patients in higher copay groups were more likely to have a history of prior MI, heart failure, and diabetes compared with the low copay group (all P P interaction=0.42). Patients in the high copay group without a voucher had similar risk of 1‐year major adverse cardiovascular events compared with patients in the high copay group with a voucher (adjusted hazard ratio, 0.89 [95% CI, 0.66–1.21]). Conclusions Medication copayment vouchers were associated with higher medication persistence at 1 year following an MI, regardless of out‐of‐pocket medication burden. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02406677. more...
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- 2022
39. Reproducibility of CMR in Patients With Cardiac Implantable Electrical Devices
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Mohammad R. Ostovaneh, Caroline Ward, Bharath Ambale-Venkatesh, Elzbieta Chamera, Yoko Kato, Roberto Bolli, Raul Mitrani, Emerson C. Perin, Timothy D. Henry, Joshua M. Hare, Lem Moyé, Saman Nazarian, and João A.C. Lima more...
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2022
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40. Comparison of Outcomes of Patients with vs without Previous Coronary Artery Bypass Graft Surgery Presenting with ST-Segment Elevation Acute Myocardial Infarction
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Yale L. Wang, Mario Goessl, Mark Tannenbaum, Ilias Nikolakopoulos, Paul Sorajja, Evangelia Vemmou, Christian W. Schmidt, Emmanouil S. Brilakis, Iosif Xenogiannis, Santiago Garcia, Scott Sharkey, Brynn Okeson, Judit Karacsonyi, Timothy D. Henry, Jay H. Traverse, Frank V. Aguirre, and M. Nicholas Burke more...
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Male ,medicine.medical_specialty ,Myocardial Infarction ,Time-to-Treatment ,Percutaneous Coronary Intervention ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,ST segment ,Hospital Mortality ,Registries ,cardiovascular diseases ,Myocardial infarction ,Coronary Artery Bypass ,Mortality ,Adverse effect ,Stroke ,Survival analysis ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Cardiology ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Artery - Abstract
The outcomes of patients with previous coronary bypass graft surgery (CABG) presenting with ST-segment elevation acute myocardial infarction (STEMI) have received limited study. We compared the clinical and procedural characteristics and outcomes of STEMI patients with and without previous CABG in a contemporary multicenter STEMI registry between 2003 and 2020. The primary outcomes of the study were mortality and major cardiac adverse events (MACE: death, MI or stroke). Survival curves were derived using the Kaplan-Meier method and compared with the log-rank test. Of the 13,893 patients included in the analyses, 7.2% had previous CABG. Mean age was 62.4 ± 13.6 years, most patients (71%) were men and 22% had diabetes. Previous CABG patients were older (69.0 ± 11.7 vs 61.9 ± 13.6 years, p0.001) and more likely to have diabetes (40% vs 21%, p0.001) compared with patients without previous CABG. Previous CABG patients had higher mortality and MACE at 5 years (p0.001). Outcomes were similar with saphenous vein graft vs native coronary culprits. Previous CABG remained associated with mortality from discharge to 18 months (p = 0.044) and from 18 months to 5 years (p0.001) after adjusting for baseline characteristics. Long term outcomes after STEMI were worse among patients with previous CABG compared with patients without previous CABG, even after adjustment for baseline characteristics. more...
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- 2021
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41. Unprotected left main occlusion: Rare but deadly
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Mehmet Yildiz and Timothy D. Henry
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
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42. ALLogeneic Heart STem Cells to Achieve Myocardial Regeneration (ALLSTAR) Trial: Rationale and Design
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Tarun Chakravarty, Raj R. Makkar, Deborah D. Ascheim, Jay H. Traverse, Richard Schatz, Anthony Demaria, Gary S. Francis, Thomas J. Povsic, Rachel R. Smith, Joao A. Lima, Janice M. Pogoda, Linda Marbán, and Timothy D. Henry more...
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Medicine - Abstract
Autologous cardiosphere-derived cells (CDCs) were the first therapeutic modality to demonstrate myocardial regeneration with a decrease in scar size and an increase in viable, functional tissue. Widespread applicability of autologous CDC therapy is limited by the need for patient-specific myocardial biopsy, cell processing, and quality control, resulting in delays to therapy and inherent logistical and economic constraints. Preclinical data had demonstrated equivalent efficiency of allogeneic to autologous CDCs. The ALLogeneic Heart STem Cells to Achieve Myocardial Regeneration (ALLSTAR) trial is a multicenter randomized, double-blind, placebo-controlled phase 1/2 safety and efficacy trial of intracoronary delivery of allogeneic CDCs (CAP-1002) in patients with myocardial infarction (MI) and ischemic left ventricular dysfunction. The phase 1 safety cohort enrolled 14 patients in an open-label, nonrandomized, dose-escalation safety trial. The phase 2 trial is a doubleblind, randomized, placebo-controlled trial that will compare intracoronary CDCs to placebo in a 2:1 allocation and will enroll up to 120 patients. The primary endpoint for both phases is safety at 1 month. For phase 2, the primary efficacy endpoint is relative change from baseline in infarct size at 12 months, as assessed by magnetic resonance imaging. The ALLSTAR trial employs a “seamless” WOVE 1 design that enables continuous enrollment from phase 1 to phase 2 and will evaluate the safety of intracoronary administration of allogeneic CDCs and its efficacy in decreasing infarct size in post-MI patients. more...
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- 2017
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43. Increasing myocardial edema is associated with greater microvascular obstruction in ST-segment elevation myocardial infarction
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Nicole L. Bonfig, Chase R. Soukup, Ananya A. Shah, Susan Olet, Sarah J. Davidson, Christian W. Schmidt, Rose Peterson, Timothy D. Henry, and Jay H. Traverse
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Percutaneous Coronary Intervention ,Treatment Outcome ,Physiology ,Physiology (medical) ,Coronary Circulation ,Microcirculation ,Myocardium ,Reperfusion Injury ,Myocardial Infarction ,Edema ,Humans ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine - Abstract
Patients with STEMI ( n = 385) had cardiac MRIs 2 to 3 days following reperfusion with primary PCI to determine the relationship between myocardial edema, LV mass, and MVO. We observed that MVO increased linearly with LV mass and that myocardial edema measured by T2-imaging also increased linearly with LV mass. Patients with MVO had greater edema and LVEDP than subjects without MVO. These findings suggest that myocardial edema which arises from ischemia-reperfusion injury may result in extravascular compression of the microcirculation manifested as MVO on cardiac MRI. more...
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- 2022
44. Mechanical Circulatory Support in COVID-19
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Kari Gorder, Wesley Young, Navin K. Kapur, Timothy D. Henry, Santiago Garcia, Raviteja R. Guddeti, and Timothy D. Smith
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Extracorporeal Membrane Oxygenation ,Shock, Cardiogenic ,COVID-19 ,Humans ,General Medicine ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine - Abstract
Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population. more...
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- 2022
45. Position Statement on Vascular Access Safety for Percutaneous Devices in AMI Complicated by Cardiogenic Shock
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Abdulla A. Damluji, Behnam Tehrani, Shashank S. Sinha, Marc D. Samsky, Timothy D. Henry, Holger Thiele, Nick E.J. West, Fortunato F. Senatore, Alexander G. Truesdell, George D. Dangas, Nathaniel R. Smilowitz, Amit P. Amin, Adam D. deVore, Nader Moazami, Joaquin E. Cigarroa, Sunil V. Rao, Mitchell W. Krucoff, David A. Morrow, and Ian C. Gilchrist more...
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Treatment Outcome ,Shock, Cardiogenic ,Myocardial Infarction ,Humans ,Hemorrhage ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,United States - Abstract
In the United States, the frequency of using percutaneous mechanical circulatory support devices for acute myocardial infarction complicated by cardiogenic shock is increasing. These devices require large-bore vascular access to provide left, right, or biventricular cardiac support, frequently under urgent/emergent circumstances. Significant technical and logistical variability exists in device insertion, care, and removal in the cardiac catheterization laboratory and in the cardiac intensive care unit. This variability in practice may contribute to adverse outcomes observed in centers that receive patients with cardiogenic shock, who are at higher risk for circulatory insufficiency, venous stasis, bleeding, and arterial hypoperfusion. In this position statement, we aim to: 1) describe the public health impact of bleeding and vascular complications in cardiogenic shock; 2) highlight knowledge gaps for vascular safety and provide a roadmap for a regulatory perspective necessary for advancing the field; 3) propose a minimum core set of process elements, or "vascular safety bundle"; and 4) develop a possible study design for a pragmatic trial platform to evaluate which structured approach to vascular access drives most benefit and prevents vascular and bleeding complications in practice. more...
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- 2022
46. Cardiology Research Internship for Undergraduate Students Provides Unique Opportunity for Next Generation of Health Care Professionals
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Jay H. Traverse, Kevin M. Harris, Scott W. Sharkey, Monique North, Timothy D. Henry, Maia Hendel, Ross Garberich, David G. Hurrell, and Jan Dick
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education ,undergraduate ,Medical education ,research ,business.industry ,Quality Improvement Project ,Viewpoint ,female ,Internship ,Health care ,premedical ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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47. Variability in reporting of key outcome predictors in acute myocardial infarction cardiogenic shock trials
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Timothy D. Henry, Santiago Garcia, Jacob C. Jentzer, David A. Baran, Sean van Diepen, Scott W. Sharkey, Christopher L. Brown, Navin K. Kapur, Jeffrey M Tyler, and Ross Garberich
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medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Shock, Cardiogenic ,Cardiac index ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,Cause of death ,Mechanical ventilation ,Ejection fraction ,business.industry ,Cardiogenic shock ,Stroke Volume ,General Medicine ,medicine.disease ,Clinical trial ,Treatment Outcome ,Cardiology ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Among acute myocardial infarction patients with cardiogenic shock (AMICS), a number of key variables predict mortality, including cardiac arrest (CA) and shock classification as proposed by Society for Cardiovascular Angiography and Intervention (SCAI). Given this prognostic importance, we examined the frequency of reporting of high risk variables in published randomized controlled trials (RCTs) of AMICS patients. Methods We identified 15 RCTs enrolling 2,500 AMICS patients and then reviewed rates of CA, baseline neurologic status, right heart catheterization data, lactate levels, inotrope and vasopressor requirement, hypothermia, mechanical ventilation, left ventricular ejection fraction (LVEF), mechanical circulatory support, and specific cause of death based on the primary manuscript and Data in S1. Results A total of 2,500 AMICS patients have been enrolled in 15 clinical trials over 21 years with only four trials enrolling >80 patients. The reporting frequency and range for key prognostic factors was: neurologic status (0% reported), hypothermia (28% reported, prevalence 33-75%), specific cause of death (33% reported), cardiac index and wedge pressure (47% reported, range 1.6-2.3 L min-1 m-2 and 15-24 mmHg), lactate (60% reported, range 4-7.7 mmol/L), LVEF (73% reported, range 25-45%), CA (80% reported, prevalence 0-92%), MCS (80% reported, prevalence 13-100%), and mechanical ventilation (93% reported, prevalence 35-100%). This variability was reflected in the 30-day mortality which ranged from 20-73%. Conclusions In a comprehensive review of seminal RCTs in AMICS, important predictors of outcome were frequently not reported. Future efforts to standardize CS trial data collection and reporting may allow for better assessment of novel therapies for AMICS. more...
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- 2021
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48. A Phase <scp>II</scp> study of autologous mesenchymal stromal cells and c‐kit positive cardiac cells, alone or in combination, in patients with ischaemic heart failure: the <scp>CCTRN CONCERT‐HF</scp> trial
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Michael P. Murphy, Ketty Bacallao, Lara M. Simpson, Aisha Khan, Joshua M. Hare, Bharath Ambale-Venkatesh, Judy Bettencourt, Dejian Lai, David P. Lee, Gregory D. Lewis, Timothy D. Henry, Bangon Longsomboon, Ray F. Ebert, Keith L. March, Mohammad R. Ostovaneh, Michelle Cohen, Ivonne Hernandez Schulman, Rachel W. Vojvodic, Carl J. Pepine, Krystalenia Valasaki, Lem Moyé, Shelly L. Sayre, Sohail Ikram, Robert D. Simari, Doris A. Taylor, Catalin Loghin, James T. Willerson, Roberto Bolli, Phillip C. Yang, David Aguilar, Barry R. Davis, Emerson C. Perin, Connor O'Brien, Adrian P. Gee, Sara Richman, Joao A.C. Lima, Raul D. Mitrani, and Jay H. Traverse more...
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medicine.medical_specialty ,Minnesota ,Phases of clinical research ,030204 cardiovascular system & hematology ,Mesenchymal Stem Cell Transplantation ,Placebo ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Humans ,Medicine ,Heart Failure ,Ejection fraction ,business.industry ,Mesenchymal stem cell ,Mesenchymal Stem Cells ,Stroke Volume ,medicine.disease ,Clinical trial ,Treatment Outcome ,Heart failure ,Quality of Life ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
AIMS CONCERT-HF is an NHLBI-sponsored, double-blind, placebo-controlled, Phase II trial designed to determine whether treatment with autologous bone marrow-derived mesenchymal stromal cells (MSCs) and c-kit positive cardiac cells (CPCs), given alone or in combination, is feasible, safe, and beneficial in patients with heart failure (HF) caused by ischaemic cardiomyopathy. METHODS AND RESULTS Patients were randomized (1:1:1:1) to transendocardial injection of MSCs combined with CPCs, MSCs alone, CPCs alone, or placebo, and followed for 12 months. Seven centres enrolled 125 participants with left ventricular ejection fraction of 28.6 ± 6.1% and scar size 19.4 ± 5.8%, in New York Heart Association class II or III. The proportion of major adverse cardiac events (MACE) was significantly decreased by CPCs alone (-22% vs. placebo, P = 0.043). Quality of life (Minnesota Living with Heart Failure Questionnaire score) was significantly improved by MSCs alone (P = 0.050) and MSCs + CPCs (P = 0.023) vs. placebo. Left ventricular ejection fraction, left ventricular volumes, scar size, 6-min walking distance, and peak oxygen consumption did not differ significantly among groups. CONCLUSIONS This is the first multicentre trial assessing CPCs and a combination of two cell types from different tissues in HF patients. The results show that treatment is safe and feasible. Even with maximal guideline-directed therapy, both CPCs and MSCs were associated with improved clinical outcomes (MACE and quality of life, respectively) in ischaemic HF without affecting left ventricular function or structure, suggesting possible systemic or paracrine cellular mechanisms. Combining MSCs with CPCs was associated with improvement in both these outcomes. These results suggest potential important beneficial effects of CPCs and MSCs and support further investigation in HF patients. more...
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- 2021
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49. Initial Findings From the North American COVID-19 Myocardial Infarction Registry
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Santiago Garcia, Payam Dehghani, Cindy Grines, Laura Davidson, Keshav R. Nayak, Jacqueline Saw, Ron Waksman, John Blair, Bagai Akshay, Ross Garberich, Christian Schmidt, Hung Q. Ly, Scott Sharkey, Nestor Mercado, Carlos E. Alfonso, Naoki Misumida, Deepak Acharya, Mina Madan, Abdul Moiz Hafiz, Nosheen Javed, Jay Shavadia, Jay Stone, M. Chadi Alraies, Wah Htun, William Downey, Brian A. Bergmark, Jospeh Ebinger, Tareq Alyousef, Houman Khalili, Chao-Wei Hwang, Joshua Purow, Alexander Llanos, Brent McGrath, Mark Tannenbaum, Jon Resar, Rodrigo Bagur, Pedro Cox-Alomar, Ada C. Stefanescu Schmidt, Lindsey A. Cilia, Farouc A. Jaffer, Michael Gharacholou, Michael Salinger, Brian Case, Ameer Kabour, Xuming Dai, Osama Elkhateeb, Taisei Kobayashi, Hahn-Ho Kim, Mazen Roumia, Frank V. Aguirre, Jeffrey Rade, Aun-Yeong Chong, Hurst M. Hall, Shy Amlani, Alireza Bagherli, Rajan A.G. Patel, David A. Wood, Frederick G. Welt, Jay Giri, Ehtisham Mahmud, and Timothy D. Henry more...
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medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Revascularization ,outcomes ,D2B, door to balloon ,PPCI, primary percutaneous coronary intervention ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Epidemiology ,PUI, person under investigation ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Registries ,Young adult ,Prospective cohort study ,Stroke ,IQR, interquartile range ,Original Investigation ,COVID-19, coronavirus disease 2019 ,SCAI, Society for Cardiac Angiography and Interventions ,business.industry ,SARS-CoV-2 ,Percutaneous coronary intervention ,COVID-19 ,STEMI, ST-segment elevation myocardial infarction ,medicine.disease ,United States ,MI, myocardial infarction ,ST Elevation Myocardial Infarction ,Observational study ,ACC, American College of Cardiology ,Cardiology and Cardiovascular Medicine ,business ,ST-segment myocardial infarction - Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). Objectives The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. Methods A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. Results As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p, Central Illustration more...
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- 2021
50. First Human Use of Shockwave L6 Intravascular Lithotripsy Catheter in Severely Calcified Large Vessel Stenoses
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J.D. Corl, Douglas Flynn, Timothy D. Henry, and Dean J. Kereiakes
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- 2023
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