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Coronary Artery Disease: HELP
Articles by Deepak L. Bhatt
Based on 136 articles published since 2009
(Why 136 articles?)
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Between 2009 and 2019, D. L. Bhatt wrote the following 136 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2016 Update. 2016

Angiolillo, Dominick J / Goodman, Shaun G / Bhatt, Deepak L / Eikelboom, John W / Price, Matthew J / Moliterno, David J / Cannon, Christopher P / Tanguay, Jean-Francois / Granger, Christopher B / Mauri, Laura / Holmes, David R / Gibson, C Michael / Faxon, David P. ·From the Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.) · St Michael's Hospital, University of Toronto, and the Canadian Heart Research Centre · Canadian VIGOUR Centre, University of Alberta, Edmonton (S.G.G.) · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B., D.P.F.) · Department of Medicine, Population Health Research Institute, Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada (J.W.E.) · Division of Cardiovascular Diseases, Scripps Clinic, La Jolla CA (M.J.P.) · Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington (D.J.M.) · Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (C.P.C., L.M.) · Department of Medicine, Montreal Heart Institute, Université de Montréal, QC, Canada (J.-F.T.) · Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.) · Mayo Clinic, Rochester, MN (D.R.H.) · and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.). ·Circ Cardiovasc Interv · Pubmed #27803042.

ABSTRACT: The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation is an emerging clinical problem. Currently, there is limited evidenced-based data on the optimal antithrombotic treatment regimen, including antiplatelet and anticoagulant therapies, for these high-risk patients with practice guidelines, thus, providing limited recommendations. Over the past years, expert consensus documents have provided guidance to clinicians on how to manage patients with atrial fibrillation undergoing percutaneous coronary intervention. Given the recent advancements in the field, the current document provides an updated opinion of selected North American experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention. In particular, this document provides the current views on (1) embolic/stroke risk, (2) ischemic/thrombotic cardiac risk, and (3) bleeding risk, which are pivotal for discerning the choice of antithrombotic therapy. In addition, we describe the recent advances in pharmacology, stent designs, and clinical trials relevant to the field. Ultimately, we provide expert consensus-derived recommendations, using a pragmatic approach, on the management of patients with atrial fibrillation undergoing percutaneous coronary intervention.

2 Editorial Long-Term Outcomes of Post-Operative Atrial Fibrillation: Guilty as Charged. 2018

Verma, Atul / Bhatt, Deepak L / Verma, Subodh. ·Department of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: atul.verma@utoronto.ca. · Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. · Department of Surgery, University of Toronto, Toronto, Canada; Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada. ·J Am Coll Cardiol · Pubmed #29447736.

ABSTRACT: -- No abstract --

3 Editorial Editorial commentary: Novel developments in revascularization for left main coronary artery disease. 2018

Carreras, Edward T / Bhatt, Deepak L. ·Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, MA, 75 Francis Street, Boston, MA 02115. · Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, MA, 75 Francis Street, Boston, MA 02115. Electronic address: dlbhattmd@post.harvard.edu. ·Trends Cardiovasc Med · Pubmed #29395781.

ABSTRACT: -- No abstract --

4 Editorial Coronary CTA in the Evaluation of Stable Chest Pain: Clear Benefits, But Not for All. 2017

Blankstein, Ron / Bittencourt, Márcio Sommer / Bhatt, Deepak L. ·Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rblankstein@partners.org. · Division of Internal Medicine, University Hospital and State of São Paulo Cancer Institute (ICESP), University of São Paulo, São Paulo, Brazil; Preventive Medicine Center Hospital Israelita Albert Einstein and School of Medicine, Faculdade Israelita de Ciência da Saúde Albert Einstein, São Paulo, Brazil. · Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. ·J Am Coll Cardiol · Pubmed #28385305.

ABSTRACT: -- No abstract --

5 Editorial Assessment of Stable Coronary Lesions. 2017

Bhatt, Deepak L. ·From Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School - both in Boston. ·N Engl J Med · Pubmed #28317425.

ABSTRACT: -- No abstract --

6 Editorial How to Decipher OCT After PCI. 2015

Sawlani, Neal N / Bhatt, Deepak L. ·Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu. ·JACC Cardiovasc Imaging · Pubmed #26563860.

ABSTRACT: -- No abstract --

7 Editorial Yes, hyperglycaemia is indeed a modifiable cardiac risk factor: so says Mendel. 2015

Bhatt, Deepak L. ·Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA DLBHATTMD@post.harvard.edu. ·Eur Heart J · Pubmed #25827603.

ABSTRACT: -- No abstract --

8 Editorial Clopidogrel resistance - a clear problem with an unclear solution. 2012

Bansilal, Sameer / Bhatt, Deepak L. · ·Indian Heart J · Pubmed #22929816.

ABSTRACT: -- No abstract --

9 Editorial Declining coronary artery bypass-related mortality: more than meets the eye? 2012

Bansilal, Sameer / Bhatt, Deepak L. ·VA Boston Healthcare System, Brigham and Women's Hospital, Boston, MA 02132, USA. ·Clin Cardiol · Pubmed #22528147.

ABSTRACT: -- No abstract --

10 Editorial Tailoring antiplatelet therapy based on pharmacogenomics: how well do the data fit? 2009

Bhatt, Deepak L. · ·JAMA · Pubmed #19706866.

ABSTRACT: -- No abstract --

11 Review Long-Term Outcomes of Drug-Eluting Stents Versus Bare-Metal Stents in End-Stage Renal Disease Patients on Dialysis: A Systematic Review and Meta-Analysis. 2018

Khera, Sahil / Villablanca, Pedro A / Kolte, Dhaval / Gupta, Tanush / Hasan Khan, Mohammed / Velagapudi, Poonam / Kalra, Ankur / Kleiman, Neal / Aronow, Herbert D / Abbott, J Dawn / Rosenfield, Kenneth / Drachman, Douglas E / Bangalore, Sripal / Bhatt, Deepak L / Naidu, Srihari S. ·From the Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. · Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. · Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI. · Division of Cardiology, New York Medical College and Westchester Medical Center, Valhalla, NY. · Harrington Heart & Vascular Institute at University Hospitals Cleveland Medical Center, Cleveland, OH. · Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX. · Division of Cardiology, New York University Medical Center, New York, NY. · Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA. ·Cardiol Rev · Pubmed #30157064.

ABSTRACT: There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel-Haenszel method. Random-effects model was used for all analyses. A total of 17 nonrandomized studies (N = 63,157; 41,621 DES and 21,536 BMS) met the inclusion criteria and were included for the final quantitative analysis: median follow-up of 1 year (range: 9 months to 6 years). The use of DES in ESRD-D patients was associated with lower all-cause mortality (OR 0.75, 95% CI 0.64-0.89, P < 0.001) compared with BMS. The use of DES was also associated with lower rates of cardiovascular mortality (OR 0.75, 95% CI 0.60-0.99, P = 0.047) and target lesion/vessel revascularization (OR 0.78, 95% CI 0.64-0.94, P = 0.01). However, there were no differences in noncardiovascular mortality, myocardial infarction, stent thrombosis, stroke, or major bleeding in DES versus BMS. In this largest meta-analysis of long-term outcomes after percutaneous coronary intervention in ESRD-D patients, DES was associated with lower rates of all-cause mortality, target lesion/vessel revascularization, and cardiovascular death.

12 Review Role of Invasive Functional Assessment in Surgical Revascularization of Coronary Artery Disease. 2018

Baibhav, Bipul / Gedela, Maheedhar / Moulton, Michael / Pavlides, Gregory / Pompili, Vincent / Rab, Tanveer / Dangas, George / Bhatt, Deepak L / Siddique, Aleem / Chatzizisis, Yiannis S. ·Cardiovascular Division (B.B., G.P. V.P., Y.S.C.). · University of Nebraska Medical Center, Omaha. Sands Constellation Heart Institute, Rochester Regional Health, NY (B.B.). · Department of Cardiovascular Diseases, University of South Dakota Sanford School of Medicine, Sioux Falls (M.G.). · Division of Cardiothoracic Surgery (M.M., A.S.). · Division of Cardiology, Emory University School of Medicine, Atlanta, GA (T.R.). · Department of Cardiovascular Medicine, Mount Sinai Hospital, New York, NY (G.D.). · Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). · Cardiovascular Division (B.B., G.P. V.P., Y.S.C.) ychatzizisis@icloud.com. ·Circulation · Pubmed #29661951.

ABSTRACT: In patients with stable coronary artery disease, percutaneous coronary intervention is associated with improved outcomes if the lesion is deemed significant by invasive functional assessment using fractional flow reserve. Recent studies have shown that a revascularization strategy using instantaneous wave-free ratio is noninferior to fractional flow reserve in patients with intermediate-grade stenoses. The decision to perform coronary artery bypass grafting surgery is usually based on anatomic assessment of stenosis severity by coronary angiography. The data on the role of invasive functional assessment in guiding surgical revascularization are limited. In this review, we discuss the diagnostic and prognostic significance of invasive functional assessment in patients considered for coronary artery bypass grafting. In addition, we critically discuss ongoing and future clinical trials on the role of invasive functional assessment in surgical revascularization.

13 Review A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease: a primer for cardiologists. 2018

Chaudhry, Sundeep / Arena, Ross / Bhatt, Deepak L / Verma, Subodh / Kumar, Naresh. ·Division of Research and Development, MET-TEST, Atlanta, Georgia. · Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois. · Executive Director of Interventional Cardiovascular Programs, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto. · Department of Research, Whitby Cardiovascular Institute, Whitby, Ontario, Canada. ·Curr Opin Cardiol · Pubmed #29240566.

ABSTRACT: PURPOSE OF REVIEW: There is growing clinical interest for the use of cardiopulmonary exercise testing (CPET) to evaluate patients with or suspected coronary artery disease (CAD). With mounting evidence, this concise review with relevant teaching cases helps to illustrate how to integrate CPET data into real world patient care. RECENT FINDINGS: CPET provides a novel and purely physiological basis to identify cardiac dysfunction in symptomatic patients with both obstructive-CAD and nonobstructive-CAD (NO-CAD). In many cases, abnormal cardiac response on CPET may be the only objective evidence of potentially undertreated ischemic heart disease. When symptomatic patients have NO-CAD on coronary angiogram, they are still at increased risk for cardiovascular events. This problem appears to be more common in women than men and may warrant more aggressive risk factor modification. As the main intervention is lifestyle (diet, smoking cessation, exercise) and medical therapy (statins, angiotensin-converting enzyme inhibitors, beta-blockers), serial CPET testing enables close surveillance of cardiovascular function and is responsive to clinical status. SUMMARY: CPET can enhance outpatient evaluation and management of CAD. Diagnostically, it can help to identify physiologically significant obstructive-CAD and NO-CAD in patients with normal routine cardiac testing. CPET may be of particular value in symptomatic women with NO-CAD. Prognostically, precise quantification of improvements in exercise capacity may help to improve long-term lifestyle and medication adherence for this chronic condition.

14 Review Culprit Vessel-Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Cardiogenic Shock Complicating ST-Segment-Elevation Myocardial Infarction: A Collaborative Meta-Analysis. 2017

Kolte, Dhaval / Sardar, Partha / Khera, Sahil / Zeymer, Uwe / Thiele, Holger / Hochadel, Matthias / Radovanovic, Dragana / Erne, Paul / Hambraeus, Kristina / James, Stefan / Claessen, Bimmer E / Henriques, Jose P S / Mylotte, Darren / Garot, Philippe / Aronow, Wilbert S / Owan, Theophilus / Jain, Diwakar / Panza, Julio A / Frishman, William H / Fonarow, Gregg C / Bhatt, Deepak L / Aronow, Herbert D / Abbott, J Dawn. ·From the Department of Medicine, Division of Cardiology, Brown University, Providence, RI (D.K., H.D.A., J.D.A.) · Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City (P.S., T.O.) · Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla (S.K., W.S.A., D.J., J.A.P., W.H.F.) · Department of Cardiology, Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z., M.H.) · Department of Cardiology, University Heart Center Lübeck, Medical Clinic II, University Hospital Schleswig-Holstein, Germany (H.T.) · German Cardiovascular Research Center (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (H.T.) · AMIS Plus Data Center, University of Zurich, Switzerland (D.R., P.E.) · Department of Cardiology, Falun Hospital, Sweden (K.H.) · Department of Medical Sciences, Uppsala University, Sweden (K.H., S.J.) · Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (B.E.C., J.P.S.H.) · Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, National University of Ireland (D.M.) · Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France (P.G.) · Department of Medicine, Division of Cardiology, David-Geffen School of Medicine, University of California at Los Angeles (G.C.F.) · and Department of Medicine, Division of Cardiology, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.). ·Circ Cardiovasc Interv · Pubmed #29146672.

ABSTRACT: BACKGROUND: The optimal revascularization strategy in patients with multivessel disease presenting with cardiogenic shock complicating ST-segment-elevation myocardial infarction remains unknown. METHODS AND RESULTS: Databases were searched from 1999 to October 2016. Studies comparing immediate/single-stage multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel-only PCI (CO-PCI) in patients with multivessel disease, ST-segment-elevation myocardial infarction, and cardiogenic shock were included. Primary end point was short-term (in-hospital or 30 days) mortality. Secondary end points included long-term mortality, cardiovascular death, reinfarction, and repeat revascularization. Safety end points were in-hospital stroke, renal failure, and major bleeding. The meta-analysis included 11 nonrandomized studies and 5850 patients (1157 MV-PCI and 4693 CO-PCI). There was no significant difference in short-term mortality with MV-PCI versus CO-PCI (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.81-1.43; CONCLUSIONS: This meta-analysis of nonrandomized studies suggests that in patients with cardiogenic shock complicating ST-segment-elevation myocardial infarction, there may be no significant benefit with single-stage MV-PCI compared with CO-PCI. Given the limitations of observational data, randomized trials are needed to determine the role of MV-PCI in this setting.

15 Review The coronary heart team. 2017

Yanagawa, Bobby / Puskas, John D / Bhatt, Deepak L / Verma, Subodh. ·aDivision of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, CanadabDepartment of Cardiothoracic Surgery, Mount Sinai Hospital, New York, New YorkcBrigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA. ·Curr Opin Cardiol · Pubmed #28797011.

ABSTRACT: PURPOSE OF REVIEW: The concept of a Coronary Heart Team has generated increased interest, including support from major practice guidelines. Here, we review the rationale and the published experience of Coronary Heart Teams. RECENT FINDINGS: A Coronary Heart Team should be led by both cardiology and cardiac surgery with a shared decision-making approach. The team should incorporate data from anatomic and clinical risk prediction models to offer individualized care. Most teams focus on management of complex patients and those with indications for both coronary artery bypass graft and percutaneous coronary intervention. The potential benefits of a Coronary Heart Team include balanced decision-making, greater adherence to evidence-based practice guidelines, as well as promoting greater collegiality and exchange of knowledge between specialties. Single-center series have demonstrated consistency in decision-making by Coronary Heart Teams but prospective data demonstrating improved patient outcomes and/or cost effectiveness are necessary. SUMMARY: The concept of a Coronary Heart Team is gaining traction for patients with complex coronary artery disease. There is a growing literature in support of Coronary Heart Teams but comparative and prospective data demonstrating improved patient outcomes are needed.

16 Review Hydrophilic vs lipophilic statins in coronary artery disease: A meta-analysis of randomized controlled trials. 2017

Bytyçi, Ibadete / Bajraktari, Gani / Bhatt, Deepak L / Morgan, Charity J / Ahmed, Ali / Aronow, Wilbert S / Banach, Maciej / Anonymous4390906. ·Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo. · Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo. · Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA. · VA Medical Center and George Washington University, Washington, DC, USA. · University of Alabama at Birmingham, Birmingham, AL, USA. · Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, NY, USA. · Department of Hypertension, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland. Electronic address: maciejbanach@aol.co.uk. ·J Clin Lipidol · Pubmed #28506385.

ABSTRACT: INTRODUCTION: Some available experimental studies have reported that hydrophilic statins might have advantages compared with lipophilic statins in patients with coronary artery disease (CAD). Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) investigating the potential differences of lipophilic and hydrophilic statins in patients with CAD. METHODS: We systematically searched selected electronic databases up to September 2016 to select RCTs, which compared clinical outcomes of hydrophilic vs lipophilic statins. Primary endpoints were cardiovascular (CV) events: major adverse cardiac events, myocardial infarction, cardiac revascularization, stroke, CV death, CV hospitalization, and all-cause mortality. Secondary endpoints were safety parameters: drug discontinuation, statin-associated muscle symptoms and alanine aminotransferase level increase. RESULTS: A total of 11,697 patients from 11 RCTs, randomly allocated to lipophilic (n = 5736) or hydrophilic statins (n = 5961), with a mean follow-up 14 months, were included in the meta-analysis. In comparison with hydrophilic, the lipophilic statins showed similar risk reduction for major adverse cardiac events (relative risk = 0.969, 95% confidence interval [CI], 0.835-1.125, P = .682), myocardial infarction (0.880, 95% CI: 0.731-1.058, P = .174), CV death (0.757, 95% CI: 0.486-1.180, P = .219), and all-cause mortality (0.797, 95% CI: 0.590-1.075, P = .137), as well as cardiac revascularization, stroke, drug discontinuation, and statin-associated muscle symptoms. CV hospitalization was lower (0.789, 95% CI: 0.643-0.969, P = .024) and alanine aminotransferase elevation was higher (2.689, 95% CI: 1.841-3.954, P ≤ .001) in lipophilic than in hydrophilic-treated patients. CONCLUSIONS: In conclusion, similarity between hydrophilic and lipophilic statins holds between various clinical CAD settings.

17 Review Antithrombotic strategies for preventing long-term major adverse cardiovascular events in patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention. 2017

Pareek, Manan / Bhatt, Deepak L / Ten Berg, Jürrien M / Kristensen, Steen D / Grove, Erik L. ·a Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School , Boston , MA , USA. · b Cardiology Section, Department of Internal Medicine , Holbaek Hospital , Holbaek , Denmark. · c Department of Cardiology , St. Antonius Hospital , Nieuwegein , The Netherlands. · d Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark. · e Faculty of Health , Institute of Clinical Medicine, Aarhus University , Aarhus , Denmark. ·Expert Opin Pharmacother · Pubmed #28489475.

ABSTRACT: INTRODUCTION: Balancing the risk of recurrent ischemia and bleeding among patients with non-valvular atrial fibrillation who undergo percutaneous coronary intervention (PCI) is challenging. Postprocedural antithrombotic therapy aims to reduce the risk related to coronary artery disease, stent placement, and atrial fibrillation, with acceptable risks of bleeding. Areas covered: This review summarizes evidence and recommendations related to long-term antithrombotic strategies in such patients. An overview of the findings from recent meta-analyses and select observational studies is provided, and important completed and ongoing randomized trials are described in detail. Recommendations pertaining to treatment intensity and duration, including the choice of specific anticoagulant and antiplatelet agents, are given. Expert opinion: Triple therapy (oral anticoagulation with dual antiplatelet therapy) is associated with an increased bleeding risk compared with double therapy (oral anticoagulation with a single antiplatelet agent), but double therapy does not appear to be associated with an increased risk of recurrent ischemia or death. Completed trials make a compelling case for double therapy with clopidogrel, not aspirin, when compared with full-intensity triple antithrombotic therapy. We believe that double therapy with an anticoagulant and clopidogrel should generally be favored instead of triple antithrombotic therapy.

18 Review Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. 2017

Khan, Abdur R / Golwala, Harsh / Tripathi, Avnish / Riaz, Haris / Kumar, Arnav / Flaherty, Michael P / Bhatt, Deepak L. ·Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville, Louisville, Kentucky. · Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. · Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio. · Heart and Vascular Center, Cleveland Clinic, Cleveland, Ohio. · Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu. ·Am J Cardiol · Pubmed #28442067.

ABSTRACT: Despite the increase in use of percutaneous coronary intervention (PCI) in left main coronary disease, its efficacy compared with coronary artery bypass grafting (CABG) is unclear. We performed a meta-analysis of randomized controlled trials to assess the optimal revascularization strategy. Our search yielded 8 studies reporting relevant outcomes that were pooled using the inverse variance method, and the hazard ratio (HR) was calculated. The primary outcome was all-cause mortality, myocardial infarction (MI), or stroke (major adverse cardiac events [MACE]), and the secondary outcome was death/MI/stroke/repeat revascularization (expanded MACE). Differences in outcomes classified by follow-up duration (early: 0 to 1 year; late: 3 to 5 years) or anatomical complexity of coronary artery disease (SYNTAX score) were investigated. Our results suggest no difference in either early or late MACE (early: HR 0.81; 95% confidence interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI 0.95 to 1.43) between the 2 groups. There was an increased risk of expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to 1.92) at late follow-up. There were comparable rates of all-cause mortality and nonprocedural MI between the 2 groups with increased rates of repeat revascularization with PCI throughout the follow-up and higher rates of stroke with coronary artery bypass grafting early in the follow-up period. In conclusion, our analysis suggests that CABG may be preferable in patients with left main disease and high SYNTAX scores, assuming they are at low surgical risk, and PCI may be an acceptable alternative in patients with low-intermediate SYNTAX scores.

19 Review Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. 2017

Costa, Francesco / van Klaveren, David / James, Stefan / Heg, Dik / Räber, Lorenz / Feres, Fausto / Pilgrim, Thomas / Hong, Myeong-Ki / Kim, Hyo-Soo / Colombo, Antonio / Steg, Philippe Gabriel / Zanchin, Thomas / Palmerini, Tullio / Wallentin, Lars / Bhatt, Deepak L / Stone, Gregg W / Windecker, Stephan / Steyerberg, Ewout W / Valgimigli, Marco / Anonymous4670899. ·Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland; Erasmus University Medical Center, Rotterdam, Netherlands; Department of Clinical and Experimental Medicine, Policlinic "G Martino", University of Messina, Messina, Italy. · Erasmus University Medical Center, Rotterdam, Netherlands; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. · Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. · Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Severance Cardiovascular Hospital, Yonsei University College of Medicine and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. · EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy. · Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France. · Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA. · Erasmus University Medical Center, Rotterdam, Netherlands. · Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland; Erasmus University Medical Center, Rotterdam, Netherlands. Electronic address: marco.valgimigli@insel.ch. ·Lancet · Pubmed #28290994.

ABSTRACT: BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y METHODS: A total of 14 963 patients treated with DAPT after coronary stenting-largely consisting of aspirin and clopidogrel and without indication to oral anticoagulation-were pooled at a single-patient level from eight multicentre randomised clinical trials with independent adjudication of events. Using Cox proportional hazards regression, we identified predictors of out-of-hospital Thrombosis in Myocardial Infarction (TIMI) major or minor bleeding stratified by trial, and developed a numerical bleeding risk score. The predictive performance of the novel score was assessed in the derivation cohort and validated in patients treated with percutaneous coronary intervention from the PLATelet inhibition and patient Outcomes (PLATO) trial (n=8595) and BernPCI registry (n=6172). The novel score was assessed within patients randomised to different DAPT durations (n=10 081) to identify the effect on bleeding and ischaemia of a long (12-24 months) or short (3-6 months) treatment in relation to baseline bleeding risk. FINDINGS: The PRECISE-DAPT score (age, creatinine clearance, haemoglobin, white-blood-cell count, and previous spontaneous bleeding) showed a c-index for out-of-hospital TIMI major or minor bleeding of 0·73 (95% CI 0·61-0·85) in the derivation cohort, and 0·70 (0·65-0·74) in the PLATO trial validation cohort and 0·66 (0·61-0·71) in the BernPCI registry validation cohort. A longer DAPT duration significantly increased bleeding in patients at high risk (score ≥25), but not in those with lower risk profiles (p INTERPRETATION: The PRECISE-DAPT score is a simple five-item risk score, which provides a standardised tool for the prediction of out-of-hospital bleeding during DAPT. In the context of a comprehensive clinical evaluation process, this tool can support clinical decision making for treatment duration. FUNDING: None.

20 Review Complete or Culprit-Only Revascularization for Patients With Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis of Randomized Trials. 2017

Elgendy, Islam Y / Mahmoud, Ahmed N / Kumbhani, Dharam J / Bhatt, Deepak L / Bavry, Anthony A. ·Department of Medicine, University of Florida, Gainesville, Florida. Electronic address: islam.elgendy@medicine.ufl.edu. · Department of Medicine, University of Florida, Gainesville, Florida. · Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. · Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. · Department of Medicine, University of Florida, Gainesville, Florida; North Florida/South Georgia Veterans Health Systems, Gainesville, Florida. ·JACC Cardiovasc Interv · Pubmed #28231899.

ABSTRACT: OBJECTIVES: The authors sought to compare the effectiveness of the different revascularization strategies in ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease undergoing primary percutaneous coronary intervention (PCI). BACKGROUND: Recent randomized trials have suggested that multivessel complete revascularization at the time of primary percutaneous coronary intervention (PCI) is associated with better outcomes, however; the optimum timing for nonculprit PCI is unknown. METHODS: Trials that randomized STEMI patients with multivessel disease to any combination of the 4 different revascularization strategies (i.e., complete revascularization at the index procedure, staged procedure during the hospitalization, staged procedure after discharge or culprit-only revascularization) were included. Random effect risk ratios (RRs) were conducted. Network meta-analysis was constructed using mixed treatment comparison models, and the 4 revascularization strategies were compared. RESULTS: A total of 10 trials with 2,285 patients were included. In the pairwise meta-analysis, complete revascularization (i.e., at the index procedure or as a staged procedure) was associated with a lower risk of major adverse cardiac events (MACE) (RR: 0.57; 95% confidence interval [CI]: 0.42 to 0.77), due to lower risk of urgent revascularization (RR: 0.44; 95% CI: 0.30 to 0.66). The risk of all-cause mortality (RR: 0.76; 95% CI: 0.52 to 1.12), and spontaneous reinfarction (RR: 0.54; 95% CI: 0.23 to 1.27) was similar. The reduction in the risk of MACE was observed irrespective of the timing of nonculprit artery revascularization in the mixed treatment model. CONCLUSIONS: Current evidence from randomized trials suggests that the risk of all-cause mortality and spontaneous reinfarction is not different among the various revascularization strategies for multivessel disease. Complete revascularization at the index procedure or as a staged procedure (either during the hospitalization or after discharge) was associated with a reduction of MACE due to reduction in urgent revascularization with no difference between these 3 strategies. Future trials are needed to determine the impact of complete revascularization on the risk of all-cause mortality and spontaneous reinfarction.

21 Review New-Generation Coronary Stents: Current Data and Future Directions. 2017

Kalra, Ankur / Rehman, Hasan / Khera, Sahil / Thyagarajan, Braghadheeswar / Bhatt, Deepak L / Kleiman, Neal S / Yeh, Robert W. ·Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA. · Weill Cornell Medical College, New York, NY, USA. · Safety, Quality, Informatics and Leadership Program, 2016-17, Harvard Medical School, Boston, MA, USA. · New York Medical College, White Plains, NY, USA. · Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA. · Brigham and Women's Heart and Vascular Center, Harvard Medical School, Boston, MA, USA. · The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. ryeh@bidmc.harvard.edu. ·Curr Atheroscler Rep · Pubmed #28220461.

ABSTRACT: PURPOSE OF REVIEW: Drug-eluting stents are the mainstay in the treatment of coronary artery disease using percutaneous coronary intervention. Innovations developed to overcome the limitations of prior generations of stents include biodegradable polymer stents, drug-eluting stents without a polymer, and bioabsorbable scaffolds. Our review briefly discusses the clinical profiles of first- and second-generation coronary stents, and provides an up-to-date overview of design, technology, and clinical safety and efficacy profiles of newer generation coronary stents discussing the relevant clinical trials in this rapidly evolving area of interventional cardiology. RECENT FINDINGS: Drug-eluting stents have previously been shown to be superior to bare metal stents. Second-generation everolimus-eluting stents have proven to have superior outcomes compared with first-generation paclitaxel- and sirolimus-eluting stents, and the second-generation zotarolimus-eluting stents appear to be similar to the everolimus-eluting stents, though with a lesser degree of evidence. Stents with biodegradable polymers have not been shown to be superior to everolimus-eluting stents. Bioabsorbable scaffolds have not demonstrated better outcomes than current standard treatment with second-generation drug-eluting stents but have showed a concerning signal of late and very late stent thrombosis. Everolimus-eluting stents have the most favorable outcomes in terms of safety as well as efficacy in patients undergoing percutaneous coronary intervention. Newer innovations such as biodegradable polymers and bioabsorbable scaffolds lack clinical data to replace second-generation drug-eluting stents as standard of care.

22 Review Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. 2017

Palmerini, Tullio / Della Riva, Diego / Benedetto, Umberto / Bacchi Reggiani, Letizia / Feres, Fausto / Abizaid, Alexandre / Gilard, Martine / Morice, Marie-Claude / Valgimigli, Marco / Hong, Myeong-Ki / Kim, Byeong-Keuk / Jang, Yangsoo / Kim, Hyo-Soo / Park, Kyung Woo / Colombo, Antonio / Chieffo, Alaide / Sangiorgi, Diego / Biondi-Zoccai, Giuseppe / Généreux, Philippe / Angelini, Gianni D / Pufulete, Maria / White, Jonathon / Bhatt, Deepak L / Stone, Gregg W. ·Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy. · Bristol Heart Institute, University of Bristol School of Clinical Sciences, Bristol, Bristol, UK. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Department of Cardiology, Brest University, Brest, France. · Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. · Swiss Cardiovascular Center, Bern, Switzerland. · Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. · San Raffaele Scientific Institute, Milan, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA. ·Eur Heart J · Pubmed #28110296.

ABSTRACT: Aim: We sought to determine whether the optimal dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) placement varies according to clinical presentation. Methods and Results: We performed an individual patient data pairwise and network meta-analysis comparing short-term (≤6-months) versus long-term (1-year) DAPT as well as 3-month vs. 6-month vs 1-year DAPT. The primary study outcome was the 1-year composite risk of myocardial infarction (MI) or definite/probable stent thrombosis (ST). Six trials were included in which DAPT after DES consisted of aspirin and clopidogrel. Among 11 473 randomized patients 6714 (58.5%) had stable CAD and 4758 (41.5%) presented with acute coronary syndrome (ACS), the majority of whom (67.0%) had unstable angina. In ACS patients, ≤6-month DAPT was associated with non-significantly higher 1-year rates of MI or ST compared with 1-year DAPT (Hazard Ratio (HR) 1.48, 95% Confidence interval (CI) 0.98-2.22; P = 0.059), whereas in stable patients rates of MI and ST were similar between the two DAPT strategies (HR 0.93, 95%CI 0.65-1.35; P = 0.71; Pinteraction = 0.09). By network meta-analysis, 3-month DAPT, but not 6-month DAPT, was associated with higher rates of MI or ST in ACS, whereas no significant differences were apparent in stable patients. Short DAPT was associated with lower rates of major bleeding compared with 1-year DAPT, irrespective of clinical presentation. All-cause mortality was not significantly different with short vs. long DAPT in both patients with stable CAD and ACS. Conclusions: Optimal DAPT duration after DES differs according to clinical presentation. In the present meta-analysis, despite the fact that most enrolled ACS patients were relatively low risk, 3-month DAPT was associated with increased ischaemic risk, whereas 3-month DAPT appeared safe in stable CAD. Prolonged DAPT increases bleeding regardless of clinical presentation. Further study is required to identify the optimal duration of DAPT after DES in individual patients based on their relative ischaemic and bleeding risks.

23 Review Optimal Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention. 2017

Majithia, Arjun / Bhatt, Deepak L. ·Landsman Heart and Vascular Center, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, USA. · Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: dlbhattmd@post.harvard.edu. ·Interv Cardiol Clin · Pubmed #27886820.

ABSTRACT: Dual antiplatelet therapy (DAPT) is an essential component of treatment in patients with coronary artery disease treated with percutaneous coronary intervention (PCI). Recommendations for duration of DAPT after PCI should consider patient-specific risk, clinical presentation, stent characteristics, and procedural factors. Prolonged DAPT results in a reduction of stent thrombosis (ST) and myocardial infarction (MI) at the cost of increased bleeding. Studies of shorter-duration DAPT demonstrate similar mortality, MI, ST, and less bleeding when compared with longer DAPT duration. We review current evidence for strategies of prolonged DAPT and abbreviated DAPT following PCI.

24 Review Optimizing the Use of Cangrelor in the Real World. 2017

Qamar, Arman / Bhatt, Deepak L. ·Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. · Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. dlbhattmd@post.harvard.edu. ·Am J Cardiovasc Drugs · Pubmed #27677505.

ABSTRACT: Thrombotic events such as myocardial infarction or stent thrombosis are the major cause of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). While current antiplatelet agents, anticoagulants, and PCI techniques have reduced the risk of thrombotic events in PCI-treated patients, a considerable hazard still remains. Cangrelor is an intravenous P2Y12 receptor antagonist that provides a rapid onset and maximal platelet inhibition, which is quickly reversible. In the large-scale CHAMPION PHOENIX trial, cangrelor was shown to reduce ischemic events significantly, including myocardial infarction and stent thrombosis, without increasing the risk of severe bleeding across the full spectrum of patients undergoing PCI, with substantial benefits in all patient subgroups examined. The pharmacologic profile of cangrelor makes it a valuable addition to the armamentarium of physicians providing care to a broad range of patients with coronary artery disease. Cangrelor is currently approved for reducing thrombotic events in patients undergoing PCI who have not been pretreated with a P2Y12 receptor inhibitor and are not receiving a glycoprotein IIb/IIIa inhibitor. Future studies are needed to determine the role of cangrelor in other clinical settings, such as upstream therapy in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS), and as a bridge to coronary artery bypass graft (CABG) or other non-cardiac surgeries in patients who require ongoing adenosine diphosphate receptor blockade.

25 Review Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation. 2015

Antoniadis, Antonios P / Mortier, Peter / Kassab, Ghassan / Dubini, Gabriele / Foin, Nicolas / Murasato, Yoshinobu / Giannopoulos, Andreas A / Tu, Shengxian / Iwasaki, Kiyotaka / Hikichi, Yutaka / Migliavacca, Francesco / Chiastra, Claudio / Wentzel, Jolanda J / Gijsen, Frank / Reiber, Johan H C / Barlis, Peter / Serruys, Patrick W / Bhatt, Deepak L / Stankovic, Goran / Edelman, Elazer R / Giannoglou, George D / Louvard, Yves / Chatzizisis, Yiannis S. ·Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. · FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. · California Medical Innovations Institute, San Diego, California. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy. · National Heart Centre Singapore, Singapore. · Department of Cardiology and Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan. · Cardiovascular Division, Department of Internal Medicine, Saga University, Saga, Japan. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy; Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. · Melbourne Medical School and Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia. · International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. · Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Institut Cardiovasculaire Paris Sud, Massy, France. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. Electronic address: ychatzizisis@icloud.com. ·JACC Cardiovasc Interv · Pubmed #26315731.

ABSTRACT: Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.

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