134 results found
Rajkumar C, Simader F, Al-Lamee R, 2023, Typical angina and coronary artery disease: is the common ground smaller than we think?, Heart, Vol: 109, Pages: 1422-1423, ISSN: 1355-6037
Foley M, Rajkumar CA, Ahmed-Jushuf F, et al., 2023, The ability of contemporary cardiologists to judge the ischemic impact of a coronary lesion visually., Cardiovasc Revasc Med
BACKGROUND: Landmark trials showed that invasive pressure measurement (Fractional Flow Reserve, FFR) was a better guide to coronary stenting than visual assessment. However, present-day interventionists have benefited from extensive research and personal experience of mapping anatomy to hemodynamics. AIMS: To determine if visual assessment of the angiogram performs as well as invasive measurement of coronary physiology. METHODS: 25 interventional cardiologists independently visually assessed the single vessel coronary disease of 200 randomized participants in The Objective Randomized Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial (ORBITA). They gave a visual prediction of the FFR and Instantaneous Wave-free Ratio (iFR), denoted vFFR and viFR respectively. Each judged each lesion on 2 occasions, so that every lesion had 50 vFFR, and 50 viFR assessments. The group consensus visual estimates (vFFR-group and viFR-group) and individual cardiologists' visual estimates (vFFR-individual and viFR-individual) were tested alongside invasively measured FFR and iFR for their ability to predict the placebo-controlled reduction in stress echo ischemia with stenting. RESULTS: Placebo-controlled ischemia improvement with stenting was predicted by vFFR-group (p < 0.0001) and viFR-group (p < 0.0001), vFFR-individual (p < 0.0001) and viFR-individual (p < 0.0001). There were no significant differences between the predictive performance of the group visual estimates and their invasive counterparts: p = 0.53 for vFFR vs FFR and p = 0.56 for viFR vs iFR. CONCLUSION: Visual assessment of the angiogram by contemporary experts, provides significant additional information on the amount of ischaemia which can be relieved by placebo-controlled stenting in single vessel coronary artery disease.
Kanagaratnam P, Francis DP, Chamie D, et al., 2023, A randomised controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalised with COVID-19: the C19-ACS trial, Journal of Thrombosis and Haemostasis, Vol: 21, Pages: 2213-2222, ISSN: 1538-7836
BACKGROUND: Patients hospitalised with COVID-19 suffer thrombotic complications. Risk factors for poor outcomes are shared with coronary artery disease. OBJECTIVES: To investigate efficacy of an acute coronary syndrome regimen in patients hospitalised with COVID-19 and coronary disease risk factors. PATIENTS/METHODS: A randomised controlled open-label trial across acute hospitals (UK and Brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28-days. Primary efficacy and safety outcomes were 30-day mortality and bleeding. The key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, death). RESULTS: 320 patients from 9 centres were randomised. The trial terminated early due to low recruitment. At 30 days there was no significant difference in mortality (intervention: 11.5% vs control: 15%, unadjusted OR 0.73, 95%CI 0.38 to 1.41, p=0.355). Significant bleeds were infrequent and not significantly different between the arms (intervention: 1.9% vs control 1.9%, p>0.999). Using a Bayesian Markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (OR 1.46, 95% CrI 0.88 to 2.37, Pr(Beta>0)=93%; adjusted OR 1.50, 95% CrI 0.91 to 2.45, Pr(Beta>0)=95%) and median time to discharge home was two days shorter (95% CrI -4 to 0, 2% probability that it was worse). CONCLUSIONS: Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.
Warisawa T, Cook CM, Kawase Y, et al., 2023, Physiology-guided PCI versus CABG for left main coronary artery disease: insights from the DEFINE-LM registry, CARDIOVASCULAR INTERVENTION AND THERAPEUTICS, Vol: 38, Pages: 287-298, ISSN: 1868-4300
Warisawa T, Cook CM, Ahmad Y, et al., 2023, Deferred Versus Performed Revascularization for Left Main Coronary Disease With Hemodynamic Significance, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 16, ISSN: 1941-7640
Foley MJ, Rajkumar CA, Ahmed-Jushuf F, et al., 2023, The Ability of Contemporary Interventional Cardiologists to Judge the Ischaemic Impact of a Coronary Lesion From Visual Inspection, Publisher: ELSEVIER SCIENCE INC, Pages: S30-S30, ISSN: 1936-8798
Foley MJ, Hall K, Howard JP, et al., 2023, Aortic Valve Calcium Score Is Associated With Acute Stroke in Transcatheter Aortic Valve Replacement Patients, Publisher: ELSEVIER SCIENCE INC, Pages: S91-S91, ISSN: 1936-8798
Price S, Kaski JC, Al-Lamee R, et al., 2023, The year in cardiovascular medicine 2022: the top 10 papers in acute cardiac care and ischaemic heart disease, EUROPEAN HEART JOURNAL, Vol: 44, Pages: 445-447, ISSN: 0195-668X
Ganesananthan S, Rajkumar CA, Foley M, et al., 2022, Remote digital smart device follow-up in prospective clinical trials: early insights from ORBITA-2, ORBITA-COSMIC, and ORBITA-STAR, EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: H32-H42, ISSN: 1520-765X
Akbari T, Al-Lamee R, 2022, Percutaneous Coronary Intervention in Multi-Vessel Disease, CARDIOVASCULAR REVASCULARIZATION MEDICINE, Vol: 44, Pages: 80-91, ISSN: 1553-8389
Morris PD, Al-Lamee RK, Berry C, 2022, Coronary physiological assessment in the catheter laboratory: haemodynamics, clinical assessment and future perspectives, HEART, Vol: 108, Pages: 1737-1746, ISSN: 1355-6037
Nowbar AN, Francis DP, Al-Lamee RK, 2022, Quality of Life Assessment in Trials of Revascularization for Chronic Stable Angina: Insights from ORBITA and the Implications of Blinding, CARDIOVASCULAR DRUGS AND THERAPY, Vol: 36, Pages: 1011-1018, ISSN: 0920-3206
Pathimagaraj R, Foley M, Nowbar A, et al., 2022, A Symptom-Stratified Analysis of the Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina Trial, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B80-B80, ISSN: 0735-1097
Rajkumar C, Foley M, Syam S, et al., 2022, The Role of the Collateral Circulation in Stable Coronary Artery Disease: A Placebo-Controlled Study in Patients With Stable Angina, 34th Annual Symposium on Transcatheter Cardiovascular Therapeutics (TCT), Publisher: ELSEVIER SCIENCE INC, Pages: B120-B121, ISSN: 0735-1097
Ganesananthan S, Rajkumar C, Foley M, et al., 2022, Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: A substudy of the ORBITA trial, European Heart Journal, Vol: 43, Pages: 3132-3145, ISSN: 0195-668X
AimsOxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. We examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome. We also determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI).Methods and resultsPatients with severe single vessel coronary artery disease were randomised 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomisation treadmill CPET, dobutamine stress-echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period. 195 patients with CPET data were randomised (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score (+0.82 segments; 95%CI, 0.40 to 1.25, P=0.0068) and lower FFR (-0.07; -0.12 to -0.02, P=0.011) compared to those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score (oxygen-pulse plateau presence [Pinteraction=0.026] and oxygen-pulse gradient [Pinteraction=0.023]) and Seattle angina physical-limitation score (oxygen-pulse plateau presence [Pinteraction=0.037]). Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse and oxygen-uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI.ConclusionAlthough selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel coronary artery disease.
Patel P, Thomas R, Hamady M, et al., 2022, Simulation training to create the gold standard framework to run the EMBIO trial (left gastric artery embolisation vs placebo), a double blinded, multi-centre, randomised controlled trial., 13th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: SPRINGER, Pages: 27-27, ISSN: 0960-8923
Al-Lamee RK, Foley M, Rajkumar CA, et al., 2022, Revascularization in stable coronary artery disease, BMJ-BRITISH MEDICAL JOURNAL, Vol: 377, ISSN: 0959-535X
Rajkumar CA, Wereski R, Parsonage W, et al., 2022, Association Between High-Sensitivity Cardiac Troponin, Myocardial Ischemia, and Revascularization in Stable Coronary Artery Disease, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 79, Pages: 2185-2187, ISSN: 0735-1097
Kelshiker M, Seligman H, Howard JAMES, et al., 2022, Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis, European Heart Journal, Vol: 43, Pages: 1582-1593, ISSN: 0195-668X
Aims: This meta-analysis aims to quantify the association of reduced coronary flow with all3 cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. Methods and Results: We systematically identified all studies between 1st January 2000 and1st August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios using a random-effects model. 79 studies, including 59,740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality (HR 3.78, 95% CI 2.39-5.97) and a higher incidence of MACE (HR 3.42, 95% CI 2.92-3.99). Each 0.1-unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR 1.16, 95% CI 1.04-1.29) and MACE (per 0.1 CFR unit HR 1.08, 95% CI 1.04-1.11)). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR 5.44, 95% CI 3.78-7.83) and MACE (HR 3.56, 95% CI 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR 3.76, 95% CI 2.35-6.00), heart failure (HR 6.38, 95% CI 1.95-20.90), heart transplant (HR 3.32, 95% CI 2.34-4.71) and diabetes mellitus (HR 7.47, 95% CI 3.37-16.55). Conclusions: Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice to target aggressive vascular risk modification for individuals at higher risk
Rajkumar CA, Ganesananthan S, Ahmad Y, et al., 2022, Mechanical thrombectomy with retrievable stents and aspiration catheters for acute ischaemic stroke: a meta-analysis of randomised controlled trials, EUROINTERVENTION, Vol: 17, Pages: E1425-+, ISSN: 1774-024X
Nowbar AN, Rajkumar C, Foley M, et al., 2022, A double-blind randomised placebo-controlled trial of percutaneous coronary intervention for the relief of stable angina without antianginal medications: design and rationale of the ORBITA-2 trial, EUROINTERVENTION, Vol: 17, Pages: 1490-+, ISSN: 1774-024X
Millenaar D, Dillmann M, Fehlmann T, et al., 2022, Sex Differences in Cardiovascular Research: A Scientometric Analysis, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 11
Kelshiker M, Seligman H, Howard JP, et al., 2022, CORONARY FLOW RESERVE AND CARDIOVASCULAR OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS, 71st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Publisher: ELSEVIER SCIENCE INC, Pages: 989-989, ISSN: 0735-1097
Seligman H, Nijjer SS, van de Hoef TP, et al., 2022, Phasic flow patterns of right versus left coronary arteries in patients undergoing clinical physiological assessment, EUROINTERVENTION, Vol: 17, Pages: 1260-+, ISSN: 1774-024X
Ahmad Y, Kane C, Arnold AD, et al., 2022, Randomized blinded placebo-controlled trials of renal sympathetic denervation for hypertension: a meta-analysis, Cardiovascular Revascularization Medicine, Vol: 34, Pages: 112-118, ISSN: 1553-8389
BackgroundThe efficacy of renal denervation has been controversial, but the procedure has now undergone several placebo-controlled trials. New placebo-controlled trial data has recently emerged, with longer follow-up of one trial and the full report of another trial (which constitutes 27% of the total placebo-controlled trial data). We therefore sought to evaluate the effect of renal denervation on ambulatory and office blood pressures in patients with hypertension.MethodsWe systematically identified all blinded placebo-controlled randomized trials of catheter-based renal denervation for hypertension. The primary efficacy outcome was ambulatory systolic blood pressure change relative to placebo. A random-effects meta-analysis was performed.Results6 studies randomizing 1232 patients were eligible. 713 patients were randomized to renal denervation and 519 to placebo. Renal denervation significantly reduced ambulatory systolic blood pressure (−3.52 mmHg; 95% CI −4.94 to −2.09; p < 0.0001), ambulatory diastolic blood pressure (−1.93 mmHg; 95% CI −3.04 to −0.83, p = 0.0006), office systolic blood pressure size (−5.10 mmHg; 95% CI −7.31 to −2.90, p < 0.0001) and office diastolic pressure (effect size −3.11 mmHg; 95% CI −4.43 to −1.78, p < 0.0001). Adverse events were rare and not more common with denervation.ConclusionsThe totality of blinded, randomized placebo-controlled data shows that renal denervation is safe and provides genuine reduction in blood pressure for at least 6 months post-procedure. If this effect continues in the long term, renal denervation might provide a life-long 10% relative risk reduction in major adverse cardiac events and 7.5% relative risk reduction in all-cause mortality.
Gallone G, Baldetti L, Angelini F, et al., 2022, The Placebo Effect on Symptoms, Quality of Life, and Functional Outcomes in Patients With Angina Pectoris: A Meta-analysis of Randomized Placebo-Controlled Trials, CANADIAN JOURNAL OF CARDIOLOGY, Vol: 38, Pages: 113-122, ISSN: 0828-282X
Al-Lamee R, Mintz GS, 2021, What are the PROSPECTs and clinical implications of vulnerable plaque?, Eur Heart J, Vol: 42, Pages: 4680-4682
Al-Lamee R, Mintz GS, 2021, What are the PROSPECTs and clinical implications of vulnerable plaque?, EUROPEAN HEART JOURNAL, Vol: 42, Pages: 4680-4682, ISSN: 0195-668X
Al-Lamee RK, Foley M, Rajkumar C, et al., 2021, Recruitment for placebo-controlled trials of interventional procedures: a patient-centred approach, EUROINTERVENTION, Vol: 17, Pages: E963-E965, ISSN: 1774-024X
Mohan P, Hartley A, Khaldi H, et al., 2021, Use of Intravascular Lithotripsy in a Population With a High Prevalence of Renal Disease and Diabetes: Insights From Real-World Data, Publisher: ELSEVIER SCIENCE INC, Pages: B169-B169, ISSN: 0735-1097
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