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Coronary Artery Disease: HELP
Articles by David R. Holmes
Based on 95 articles published since 2008
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Between 2008 and 2019, D. R. Holmes wrote the following 95 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
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 Guideline ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. 2012

Anonymous780721 / Patel, Manesh R / Dehmer, Gregory J / Hirshfeld, John W / Smith, Peter K / Spertus, John A / Anonymous790721 / Masoudi, Frederick A / Dehmer, Gregory J / Patel, Manesh R / Smith, Peter K / Chambers, Charles E / Ferguson, T Bruce / Garcia, Mario J / Grover, Frederick L / Holmes, David R / Klein, Lloyd W / Limacher, Marian C / Mack, Michael J / Malenka, David J / Park, Myung H / Ragosta, Michael / Ritchie, James L / Rose, Geoffrey A / Rosenberg, Alan B / Russo, Andrea M / Shemin, Richard J / Weintraub, William S / Anonymous800721 / Wolk, Michael J / Bailey, Steven R / Douglas, Pamela S / Hendel, Robert C / Kramer, Christopher M / Min, James K / Patel, Manesh R / Shaw, Leslee / Stainback, Raymond F / Allen, Joseph M / Anonymous810721 / Anonymous820721 / Anonymous830721 / Anonymous840721 / Anonymous850721 / Anonymous860721 / Anonymous870721 / Anonymous880721. · ·J Thorac Cardiovasc Surg · Pubmed #22424518.

ABSTRACT: The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.

3 Editorial Moore's Law: Apples and Oranges. 2015

Holmes, David R / Mack, Michael J. ·Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: holmes.david@mayo.edu. · Heart Hospital Baylor Plano, Baylor University, Dallas, Texas. ·JACC Cardiovasc Interv · Pubmed #26585616.

ABSTRACT: -- No abstract --

4 Editorial Do we need a better mouse trap? 2011

Holmes, David R / Sandhu, Gurpreet S. · ·Eur Heart J · Pubmed #20462976.

ABSTRACT: -- No abstract --

5 Editorial Next-generation drug-eluting stents: a spirited step forward or more of the same. 2008

Patel, Manesh R / Holmes, David R. · ·JAMA · Pubmed #18430915.

ABSTRACT: -- No abstract --

6 Review Revascularization in stable coronary artery disease: a combined perspective from an interventional cardiologist and a cardiac surgeon. 2016

Holmes, David R / Taggart, David P. ·Mayo Clinic College of Medicine and Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA. · Cardiovascular Surgery, Oxford University, John Radcliffe Hospital, UK david.taggart@ouh.nhs.uk. ·Eur Heart J · Pubmed #26994152.

ABSTRACT: It is now half a century since the start of coronary bypass graft surgery (CABG) with the first percutaneous coronary intervention (PCI) following just over a decade later. The relative merits of PCI vs. CABG for stable coronary artery disease (stable-CAD) have continued to be debated ever since and have been the focus of around 20 randomized trials and numerous registry studies, systematic reviews, and meta-analyses. The aim of this review is to identify areas of agreement, disagreement, and uncertainties in the role of PCI and CABG in patients with stable-CAD.

7 Review Controversies surrounding percutaneous coronary intervention in the diabetic patient. 2016

Martinez, Sara C / Holmes, David R. ·a Division of Cardiovascular Disease , Mayo Clinic , Rochester , MN , USA. ·Expert Rev Cardiovasc Ther · Pubmed #26837264.

ABSTRACT: Diabetic patients with coronary artery disease are common and complex, with an aggressive progression of atherosclerosis, increased rate of stent complications, and increased rates of incomplete revascularization in multivessel disease compared to non-diabetic patients. In this review, we first discuss the pathophysiologic elements of insulin resistance and presentations of coronary artery disease in diabetic patients. Next, we outline the evolution and present the data on revascularization strategies on diabetic patient outcomes. The overall conclusion of our review is that a strategy of complete and durable revascularization and guideline-directed medical therapy currently provides the best possible chance at closing the gap between outcomes in patients with and without diabetes.

8 Review Sudden cardiac death from the perspective of coronary artery disease. 2014

Sara, Jaskanwal D / Eleid, Mackram F / Gulati, Rajiv / Holmes, David R. ·Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. Electronic address: holmes.david@mayo.edu. ·Mayo Clin Proc · Pubmed #25440727.

ABSTRACT: Sudden cardiac death accounts for approximately 50% of all deaths attributed to cardiovascular disease in the United States. It is most commonly associated with coronary artery disease and can be its initial manifestation or may occur in the period after an acute myocardial infarction. Decreasing the rate of sudden cardiac death requires the identification and treatment of at-risk patients through evidence-based pharmacotherapy and interventional strategies aimed at primary and secondary prevention. For this review, we searched PubMed for potentially relevant articles published from January 1, 1970, through March 1, 2014, using the following key search terms: sudden cardiac death, ischemic heart disease, coronary artery disease, myocardial infarction, and cardiac arrest. Searches were enhanced by scanning bibliographies of identified articles, and those deemed relevant were selected for full-text review. This review outlines various mechanisms for sudden cardiac death in the setting of coronary artery disease, describes risk factors for sudden cardiac death, explores the management of cardiac arrest, and outlines optimal practice for the monitoring and treatment of patients after an acute ST-segment elevation myocardial infarction to decrease the risk of sudden death.

9 Review The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. 2013

Head, Stuart J / Kaul, Sanjay / Mack, Michael J / Serruys, Patrick W / Taggart, David P / Holmes, David R / Leon, Martin B / Marco, Jean / Bogers, Ad J J C / Kappetein, A Pieter. ·Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. ·Eur Heart J · Pubmed #23425523.

ABSTRACT: Stable complex coronary artery disease can be treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy. Multidisciplinary decision-making has gained more emphasis over the recent years to select the most optimal treatment strategy for individual patients with stable complex coronary artery disease. However, the so-called 'Heart Team' concept has not been widely implemented. Yet, decision-making has shown to remain suboptimal; there is large variability in PCI-to-CABG ratios, which may predominantly be the consequence of physician-related factors that have raised concerns regarding overuse, underuse, and inappropriate selection of revascularization. In this review, we summarize these and additional data to support the statement that a multidisciplinary Heart Team consisting of at least a clinical/non-invasive cardiologist, interventional cardiologist, and cardiac surgeon, can together better analyse and interpret the available diagnostic evidence, put into context the clinical condition of the patient as well as consider individual preference and local expertise, and through shared decision-making with the patient can arrive at a most optimal joint treatment strategy recommendation for patients with stable complex coronary artery disease. In addition, other aspects of Heart Team decision-making are discussed: the organization and logistics, involvement of physicians, patients, and assisting personnel, the need for validation, and its limitations.

10 Review Drug-eluting coronary-artery stents. 2013

Stefanini, Giulio G / Holmes, David R. ·Department of Cardiology, Bern University Hospital, Bern, Switzerland. giulio.stefanini@insel.ch ·N Engl J Med · Pubmed #23323902.

ABSTRACT: -- No abstract --

11 Review Complete versus incomplete revascularization with coronary artery bypass graft or percutaneous intervention in stable coronary artery disease. 2012

Gössl, Mario / Faxon, David P / Bell, Malcolm R / Holmes, David R / Gersh, Bernard J. ·Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. ·Circ Cardiovasc Interv · Pubmed #22896575.

ABSTRACT: -- No abstract --

12 Review How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease? 2011

Widimsky, Petr / Holmes, David R. ·Cardiocenter, Third Faculty of Medicine, Charles University Prague, Hospital Kralovske Vinohrady, Prague 10, Czech Republic. widim@fnkv.cz ·Eur Heart J · Pubmed #21118854.

ABSTRACT: Over 50% of ST-segment elevation myocardial infarction (STEMI) patients suffer multi-vessel coronary artery disease, which is known to be associated with worse prognosis. Treatment strategies used in clinical practice vary from acute multi-vessel percutaneous coronary intervention (PCI), through staged PCI procedures to a conservative approach with primary PCI of only the infarct-related artery (IRA) and subsequent medical therapy unless recurrent ischaemia occurs. Each approach has advantages and disadvantages. This review paper summarizes the international experience and authors' opinion on this clinically important question. Multi-vessel disease in STEMI is not a single entity and thus the treatment approach should be individualized. However, the following general rules can be proposed till future large randomized trials prove otherwise: (i) Single-vessel acute PCI should be the default strategy (to treat only the IRA during the acute phase of STEMI). (ii) Acute multi-vessel PCI can be justified only in exceptional patients with multiple critical (>90%) and potentially unstable lesions. (iii) Significant lesions of the non-infarct arteries should be treated either medically or by staged revascularization procedures-both options are currently acceptable.

13 Review Use of drug-eluting stents in patients with coronary artery disease and renal insufficiency. 2010

El-Menyar, Ayman A / Al Suwaidi, Jassim / Holmes, David R. ·Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital and Weill Cornell Medical College in Qatar, Doha, Qatar. ·Mayo Clin Proc · Pubmed #20118392.

ABSTRACT: Renal insufficiency (RI) has been shown to be associated with increased major adverse cardiovascular events after percutaneous coronary intervention. We reviewed the impact of RI on the pathogenesis of coronary artery disease and outcomes after percutaneous coronary intervention in the form of drug-eluting stent (DES) implantation in these high-risk patients. We searched the English-language literature indexed in MEDLINE, Scopus, and EBSCO Host research databases from 1990 through January 2009, using as search terms coronary revascularization, drug-eluting stent, and renal insufficiency. Studies that assessed DES implantation in patients with various degrees of RI were selected for review. Most of the available data were extracted from observational studies, and data from randomized trials formed the basis of a post hoc analysis. The outcomes after coronary revascularization were less favorable in patients with RI than in those with normal renal function. In patients with RI, DES implantation yielded better outcomes than did use of bare-metal stents. Randomized trials are needed to define optimal treatment of these high-risk patients with coronary artery disease.

14 Review Combining antiplatelet and anticoagulant therapies. 2009

Holmes, David R / Kereiakes, Dean J / Kleiman, Neal S / Moliterno, David J / Patti, Giuseppe / Grines, Cindy L. ·Mayo Clinic Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. holmes.david@mayo.edu ·J Am Coll Cardiol · Pubmed #19573725.

ABSTRACT: Antiplatelet therapy is the cornerstone for both primary and secondary prevention therapies for ischemic events resulting from coronary atherosclerotic disease. Dual antiplatelet therapy (aspirin plus a thienopyridine, usually clopidogrel) has assumed a central role in the treatment of acute coronary syndromes and after coronary stent deployment. In addition to antiplatelet therapy, anticoagulant therapy might be indicated for stroke prevention in a variety of conditions that include atrial fibrillation, profound left ventricular dysfunction, and after mechanical prosthetic heart valve replacement. For this reason, the use of triple antithrombotic therapy (a dual antiplatelet regimen plus warfarin) is expected to become more prominent, given an aging patient population. But although triple therapy can prevent both thromboembolism and stent thrombosis, it is also associated with significant bleeding hazards. Furthermore, when bleeding events do occur, the challenge of balancing the risk of stent thrombosis or stroke and the need for hemostasis requires considerable expertise. It is both prudent and timely to review treatment strategies that employ combinations of antiplatelet and anticoagulant therapies as well as strategies aimed at reducing bleeding risk in patients treated with these therapies.

15 Review Challenges of antiplatelet therapy in patients who require anticoagulation. 2009

Henkel, Danielle M / Holmes, David R. ·Mayo Clinic College of Medicine, Rochester, MN, 55905 USA. ·J Invasive Cardiol · Pubmed #19342758.

ABSTRACT: -- No abstract --

16 Review Catheter-based treatment of coronary artery disease: past, present, and future. 2008

Holmes, David R / Williams, David O. ·Mayo Clinic, Rochester, MN 55901, USA. holmes.david@mayo.edu ·Circ Cardiovasc Interv · Pubmed #20031656.

ABSTRACT: September 2007 marked the 30-year anniversary of the first human percutaneous coronary intervention, an index event that changed the course of modern-day cardiovascular care. Before that first procedure, adult invasive cardiology focused on diagnostic angiography as well as hemodynamic assessment of structural heart disease. Since that initial procedure, percutaneous coronary intervention has become the most frequently performed coronary revascularization procedure worldwide. Several factors have been responsible for this dramatic paradigm shift, the most prominent being identification of opportunities for technical improvement and the application of innovation and investigation in concert with colleagues, professional societies, and industry. These approaches will continue to be of paramount importance as new technologies are brought to bear on an increasingly broader group of patients with cardiovascular disease.

17 Review Technology insight: in vivo coronary plaque classification by intravascular ultrasonography radiofrequency analysis. 2008

König, Andreas / Margolis, M Pauliina / Virmani, Renu / Holmes, David / Klauss, Volker. ·Department of Cardiology, Medizinische Poliklinik-Campus Innenstadt, Ludwig-Maximilians-Universität, Munich, Germany. koenig@med.uni-muenchen.de ·Nat Clin Pract Cardiovasc Med · Pubmed #18301388.

ABSTRACT: Acute coronary syndromes or sudden coronary death are often the first manifestations of coronary artery disease. In the majority of patients, acute coronary syndrome events are caused by plaque rupture in flow-limiting and non-flow-limiting angiographically intermediate stenoses. Histopathologic analyses have shown that plaque composition is related to the occurrence of acute clinical events and, therefore, to the vulnerability of the plaque. The emerging importance of adaptive coronary remodeling processes, such as the compensatory enlargement of the coronary artery in response to initial lesion development, has focused our interest on the nonstenotic lesions of the coronary tree. In vivo intravascular ultrasonography can demonstrate the discrepancies between the actual extent of coronary atherosclerosis and that seen by angiographic imaging. The spectral analysis of intravascular ultrasonography derived radiofrequency data enables more precise analysis of plaque composition and type than grayscale intravascular ultrasonography.

18 Clinical Trial The impact of a second arterial graft on 5-year outcomes after coronary artery bypass grafting in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery Trial and Registry. 2015

Parasca, Catalina A / Head, Stuart J / Mohr, Friedrich W / Mack, Michael J / Morice, Marie-Claude / Holmes, David R / Feldman, Ted E / Colombo, Antonio / Dawkins, Keith D / Serruys, Patrick W / Kappetein, Arie Pieter / Anonymous5470832. ·Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Cardiac Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany. · The Heart Hospital, Baylor Health Care Systems, Plano, Tex. · Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France. · Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minn. · Department of Cardiology, North Shore University Health System, Evanston, Ill. · Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy. · Boston Scientific Corporation, Natick, Mass. · Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands. · Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: a.kappetein@erasmusmc.nl. ·J Thorac Cardiovasc Surg · Pubmed #26055439.

ABSTRACT: OBJECTIVE: Despite various evidence supporting the advantages of multiple arterial grafting, inconsistencies in use of the procedure have resulted in high variability in the acceptance and practice of arterial grafting. The purpose of this study was to assess the effects of an arterial versus venous second grafts on outcomes at 5-year follow-up in the coronary artery bypass grafting population from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. METHODS: Patients (n = 1419) with an arterial graft to the left anterior descending artery and ≥1 other graft were included and divided according to the second graft's type: 2nd-graft-arterial group (n = 456) and 2nd-graft-venous group (n = 963). Five-year outcomes were compared between subgroups. Event rates were estimated with Kaplan-Meier analyses. Propensity-score matching was used, to control for selection bias due to nonrandom group assignment in a 1:1 manner, resulting in 432 pairs with balanced baseline characteristics. RESULTS: In unmatched groups, the 2nd-graft-arterial group had significantly lower rates of death (8.9% vs 13.1%; P = .02), and composite safety endpoint of death/stroke/myocardial infarction (13.3% vs 18.7%; P = .02), compared with the 2nd-graft-venous group. The rate of major adverse cardiac or cerebrovascular events was similar between groups (22.9% vs 25.5%; P = .30), because it includes the rate of repeat revascularization (12.6% in the 2nd-graft-arterial group vs 9.6% in the 2nd-graft-venous group; P = .10). After propensity-score matching, no statistically significant differences were found between groups. CONCLUSIONS: This study reveals comparable 5-year outcomes with arterial and venous conduits as second grafts after an arterial graft anastomosed to the left anterior descending artery. This study demonstrates the multi-institutional variation in patient selection and operator technique with regard to arterial revascularization, although extended follow-up beyond 5 years is required to estimate its impact on long-term outcomes. CLINICAL TRIAL NUMBER: NCT00114972.

19 Article Pregnancy history, coronary artery calcification and bone mineral density in menopausal women. 2018

Beckman, J P / Camp, J J / Lahr, B D / Bailey, K R / Kearns, A E / Garovic, V D / Jayachandran, M / Miller, V M / Holmes, D R. ·a Department of Surgery , Mayo Clinic , Rochester , MN , USA. · b Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , MN , USA. · c Department of Health Science Research, Division of Biostatistics , Mayo Clinic , Rochester , MN , USA. · d Department of General Internal Medicine, Division of Endocrinology , Mayo Clinic , Rochester , MN , USA. · e Department of General Internal Medicine, Division of Nephrology and Hypertension , Mayo Clinic , Rochester , MN , USA. ·Climacteric · Pubmed #29189095.

ABSTRACT: OBJECTIVE: This study examined relationships, by pregnancy histories, between bone mineral density (BMD) and coronary artery calcification (CAC) in postmenopausal women. METHODS: Forty women identified from their medical record as having pre-eclampsia (PE) were age/parity-matched with 40 women having a normotensive pregnancy (NP). Vertebral (T4-9) BMD and CAC were assessed by quantitative computed tomography in 73 (37 with PE and 36 with NP) of the 80 women. Analyses included linear regression using generalized estimating equations. RESULTS: Women averaged 59 years of age and 35 years from the index pregnancy. There were no significant differences in cortical, trabecular or central BMD between groups. CAC was significantly greater in the PE group (p = 0.026). In multivariable analysis, CAC was positively associated with cortical BMD (p = 0.001) and negatively associated with central BMD (p = 0.036). There was a borderline difference in the association between CAC and central BMD by pregnancy history (interaction, p = 0.057). CONCLUSIONS: Although CAC was greater in women with a history of PE, vertebral BMD did not differ between groups. However, both cortical and central BMD were associated with CAC. The central BMD association was marginally different by pregnancy history, suggesting perhaps differences in underlying mechanisms of soft tissue calcification.

20 Article Rationale and design of the Drug-Eluting Stents vs Bare-Metal Stents in Saphenous Vein Graft Angioplasty (DIVA) Trial. 2017

Brilakis, Emmanouil S / Banerjee, Subhash / Edson, Robert / Shunk, Kendrick / Goldman, Steven / Holmes, David R / Bhatt, Deepak L / Rao, Sunil V / Smith, Mark W / Sather, Mike / Colling, Cindy / Kar, Biswajit / Nielsen, Lori / Conner, Todd / Wagner, Todd / Rangan, Bavana V / Ventura, Beverly / Lu, Ying / Holodniy, Mark / Shih, Mei-Chiung. ·VA North Texas Health Care System, Dallas. · Minneapolis Heart Institute, Minneapolis, Minnesota. · University of Texas Southwestern Medical School, Dallas. · VA Cooperative Studies Program Coordinating Center, Mountain View, California. · San Francisco VA Medical Center, San Francisco, California. · University of California, San Francisco. · University of Arizona Sarver Heart Center, Tucson. · Mayo Clinic, Rochester, Minnesota. · VA Boston Healthcare System, Boston, Massachusetts. · Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts. · Harvard Medical School, Boston, Massachusetts. · Durham VA Medical Center, Durham, North Carolina. · Duke University, Durham, North Carolina. · Truven Health Analytics, Ann Arbor, Michigan. · VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico. · University of Texas Medical School, Houston. · Michael E. DeBakey VA Medical Center, Houston, Texas. · VA Health Economics Resource Center, Menlo Park, California. · Stanford University, Department of Surgery, Palo Alto, California. · Stanford University, Department of Biomedical Data Science, Palo Alto, California. · Stanford University, Department of Medicine, Palo Alto, California. ·Clin Cardiol · Pubmed #28841230.

ABSTRACT: VA Cooperative Studies Program #571 (DIVA) was designed to evaluate the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure when compared with bare-metal stents (BMS) in participants undergoing stenting of de novo SVG lesions. Participants undergoing clinically indicated stenting of de novo SVG lesions were randomized in a 1:1 ratio to DES or BMS. Randomization was stratified by presence/absence of diabetes mellitus and the number of target SVG lesions (1 vs ≥2) within each participating site. At sites that did not routinely administer 12-months of dual antiplatelet therapy after SVG stenting participants without acute coronary syndromes received 1 month of open-label clopidogrel, followed by 11 months of clopidogrel for those assigned to DES and 11 months of placebo for those assigned to BMS. The primary endpoint was the 12-month incidence of target-vessel failure (defined as the composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). Secondary endpoints included the incidence of other clinical endpoints and the incremental cost-effectiveness of DES relative to BMS. Due to lower-than-anticipated target-vessel failure rates, target enrollment was increased from 519 to 762. The study had randomized 599 participants when recruitment ended in December 2015. The DIVA trial will provide clarity on the appropriate stent type for de novo SVG lesions.

21 Article Influence of practice patterns on outcome among countries enrolled in the SYNTAX trial: 5-year results between percutaneous coronary intervention and coronary artery bypass grafting. 2017

Milojevic, Milan / Head, Stuart J / Mack, Michael J / Mohr, Friedrich W / Morice, Marie-Claude / Dawkins, Keith D / Holmes, David R / Serruys, Patrick W / Kappetein, Arie Pieter. ·Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. · Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, TX, USA. · Department of Cardiovascular Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany. · Department of Cardiology, Institut Hospitalier Jacques Cartier, Massy, France. · Boston Scientific Corporation, Natick, MA, USA. · Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN, USA. · Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands. ·Eur J Cardiothorac Surg · Pubmed #28520861.

ABSTRACT: OBJECTIVES: To examine differences among participating countries in baseline characteristics, clinical practice, medication strategies and outcomes of patients randomized to coronary artery bypass grafting and percutaneous coronary intervention in the SYNTAX trial. METHODS: In SYNTAX, centres in 18 different countries enrolled 1800 patients, of which 8 countries enrolled ≥80 patients, what was projected to be a large enough sample size to be included in the analysis. Baseline characteristics, practice patterns and clinical outcomes were compared between the USA (n = 245), the UK (n = 267), Italy (n = 197), France (n = 208), Germany (n = 179), Netherlands (n = 148), Belgium (n = 91) and Hungary (n = 83). The remaining patients from other participating countries were pooled together (n = 382). RESULTS: Five-year results demonstrated significantly different outcomes between countries. After adjustment, percutaneous coronary intervention patients in France had lower rates of major adverse cardiac and cerebrovascular events [hazard ratio (HR) = 0.60, 95% confidence interval (CI) 0.37-0.98], while the incidence of repeat revascularization was higher in Hungary (HR = 1.89, 95% CI 1.14-3.42). Coronary artery bypass grafting showed the lowest rate of repeat revascularization in the UK (HR = 0.32, 95% CI 0.12-0.85). There were numerous differences in the risk profile of patients between participating countries, as well as marked differences in surgical practice across countries in the use of blood cardioplegia (range 3.1-89.0%; P < 0.001), bilateral internal mammary artery usage (range 7.8-68.2%; P < 0.001) and off-pump procedures (range 3.9-44.4%; P < 0.001). Variation was also found for percutaneous coronary intervention in the number of implanted stents (range 4.0 ± 2.3 to 6.1 ± 2.6; P < 0.001) as well as for the entire stents length (range 69.0 ± 45.1 to 124.1 ± 60.9; P < 0.001). Remarkable differences were observed in the prescription of post-coronary artery bypass grafting medication in terms of acetylsalicylic acid (range 79.6-95.0%; P = 0.004), thienopyridine (6.8-31.1%; P < 0.001) and statins (41.3-89.1%; P < 0.001). CONCLUSIONS: Patient characteristics and clinical patterns are significantly different between countries, resulting in significantly different 5-year outcomes. This article presents specific data that can further improve outcomes in each country. Clinical Trials Registry: NCT00114972.

22 Article Incidence, Characteristics, Predictors, and Outcomes of Repeat Revascularization After Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: The SYNTAX Trial at 5 Years. 2016

Parasca, Catalina A / Head, Stuart J / Milojevic, Milan / Mack, Michael J / Serruys, Patrick W / Morice, Marie-Claude / Mohr, Friedrich W / Feldman, Ted E / Colombo, Antonio / Dawkins, Keith D / Holmes, David R / Kappetein, Pieter A / Anonymous3770891. ·Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: s.head@erasmusmc.nl. · The Heart Hospital, Baylor Health Care Systems, Plano, Texas. · Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Cardiology, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de Santé, Massy, France. · Department of Cardiac Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany. · Department of Cardiology, North Shore University Health System, Evanston, Illinois. · Department of Cardiology, San Raffaele Scientific Institute, Milan, Italy. · Boston Scientific Corporation, Natick, Massachusetts. · Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota. ·JACC Cardiovasc Interv · Pubmed #28007201.

ABSTRACT: OBJECTIVES: The study sought to determine the incidence, predictors, characteristics, and outcomes of repeat revascularization during 5-year follow-up of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) trial. BACKGROUND: Limited in-depth long-term data on repeat revascularization are available from randomized trials comparing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). METHODS: Incidence and timing of repeat revascularization and its relation to the long-term composite safety endpoint of death, stroke, and myocardial infarction were analyzed in the SYNTAX trial (n = 1,800) using Kaplan-Meier analysis. RESULTS: At 5 years, repeat revascularization occurred more often after initial PCI than after initial CABG (25.9% vs. 13.7%, respectively; p < 0.001), and more often consisted of multiple repeat revascularizations (9.0% vs. 2.8%, respectively; p = 0.022). Significantly more repeat PCI procedures were performed on de novo lesions in patients after initial PCI than initial CABG (33.3% vs. 13.4%, respectively; p < 0.001). At 5-year follow-up, patients who underwent repeat revascularization versus patients not undergoing repeat revascularization had significantly higher rates of the composite safety endpoint of death, stroke, and myocardial infarction after initial PCI (33.8% vs. 16.6%, respectively; p < 0.001), and a trend was found after initial CABG (22.4% vs. 15.8%, respectively; p = 0.07). After multivariate adjustment, repeat revascularization was an independent predictor of the composite safety endpoint after both initial PCI (hazard ratio [HR]: 2.2; 95% confidence interval [CI]: 1.6 to 3.0; p < 0.001) and initial CABG (HR: 1.8; 95% CI: 1.2 to 2.9; p = 0.011). CONCLUSIONS: Repeat revascularization rates are significantly higher after initial PCI than after initial CABG for complex coronary disease. Repeat revascularization is an independent predictor of death, stroke, and myocardial infarction for myocardial revascularization.

23 Article Randomised trials in left main disease: a NOBLE effort. 2016

Mack, Michael / Holmes, David R. ·Baylor Scott & White Health, 3110 Allied Drive, Plano, TX 75093, USA. Electronic address: michael.mack@bswhealth.org. · Mayo Clinic, Rochester, MN, USA. ·Lancet · Pubmed #27810311.

ABSTRACT: -- No abstract --

24 Article Perioperative Cardiovascular Risk of Prior Coronary Stent Implantation Among Patients Undergoing Noncardiac Surgery. 2016

Mahmoud, Karim D / Sanon, Saurabh / Habermann, Elizabeth B / Lennon, Ryan J / Thomsen, Kristine M / Wood, Douglas L / Zijlstra, Felix / Frye, Robert L / Holmes, David R. ·Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. · Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. · Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. · Division of Heath Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Center for Innovation, Mayo Clinic, Rochester, Minnesota. · Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: holmes.david@mayo.edu. ·J Am Coll Cardiol · Pubmed #26940923.

ABSTRACT: BACKGROUND: Previous studies have observed high rates of perioperative cardiovascular events in patients with coronary stents undergoing noncardiac surgery (NCS). It is uncertain whether this finding reflects an independent association. OBJECTIVES: The goal of this study was to assess the independent relationship between prior coronary stent implantation and the occurrence of perioperative major adverse cardiac and cerebrovascular events (MACCE) and bleeding and its relation with time from stenting to NCS. METHODS: A total of 24,313 NCS cases at the Mayo Clinic (Rochester, Minnesota) from 2006 through 2011 were included in the study; 1,120 (4.6%) cases involved patients with coronary stents. MACCE was defined as death, myocardial infarction, cardiac arrest, or stroke. Age-adjusted odds ratios (aORs) were calculated after propensity adjustment for Revised Cardiac Risk Index factors and other conventional risk factors. RESULTS: The 30-day MACCE rates were 3.7% and 1.5% in stented and unstented patients, respectively (p < 0.001). The risk of MACCE was largely related to the time from stent implantation to NCS, indicating substantially elevated risk in the first year after stenting (aOR: 2.59; 95% confidence interval [CI]: 1.36 to 4.94) but not thereafter (aOR: 0.89; 95% CI: 0.59 to 1.36). Bleeding displayed a similar pattern, indicating elevated risk in the first year after stenting (aOR: 2.23; 95% CI: 1.55 to 3.21) but not thereafter (aOR: 1.07; 95% CI: 0.89 to 1.28). Subgroup analysis in patients with known stent type found that the increased risk of both MACCE and bleeding >1 month after stent implantation was not limited to only those with drug-eluting stents. CONCLUSIONS: This study found that prior coronary stent implantation is an independent risk factor for MACCE and bleeding when time from stenting to NCS is <1 year, both in patients with bare-metal and drug-eluting stents.

25 Article Utility of the Framingham Risk Score in predicting secondary events in patients following percutaneous coronary intervention: A time-trend analysis. 2016

Sara, Jaskanwal D S / Lennon, Ryan J / Gulati, Rajiv / Singh, Mandeep / Holmes, David R / Lerman, Lilach O / Lerman, Amir. ·Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN. · Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN. · Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. · Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN. Electronic address: lerman.amir@mayo.edu. ·Am Heart J · Pubmed #26856223.

ABSTRACT: BACKGROUND: The Framingham Risk Score (FRS) effectively predicts the risk of cardiovascular events in the primary prevention setting. However, its use in identifying the risk of cardiovascular events among patients with established coronary heart disease is unknown. This study aimed to evaluate the utility of the FRS in predicting long-term secondary events in patients following percutaneous coronary intervention (PCI) across a 17-year period. METHODS: Consecutive patients (N=25,519, male=71%, mean age=66.5±12.1years) undergoing PCI at Mayo Clinic between January 1, 1994, and December 31, 2010, were screened for cardiovascular risk factors to determine their FRS at baseline (mean score 7.0±3.3). Patients were divided into 4 groups according to their FRS 10-year predicted risk of cardiovascular disease (CVD) and were followed up for a median duration of 109months (Q1-Q3, 63-155) for the primary composite end point of cardiac death and myocardial infarction (MI) and the secondary end points of all-cause death, noncardiac death, and revascularization (surgical and percutaneous). Patients were separately divided into 5 equal temporal subsets depending on the date of PCI and were fit to a Cox model with an interaction between the FRS 10-year predicted risk and time. RESULTS: The FRS was significantly associated with the 10-year actual risk of cardiac death and MI (both combined and separately, P<.001 respectively), noncardiac death (P<.001), all-cause death (P<.001), and revascularization (P=.018). However, the FRS discriminated risk poorly for all end points (C-statistic: cardiac death and MI, 56.8; all-cause death, 58.7; noncardiac death, 51.8; and revascularization, 51.3) even among patients presenting with acute coronary syndrome or stable angina. Over the 17-year period of time, the association between the FRS 10-year predicted risk and the 10-year actual risk of events did not change (P=.72). CONCLUSIONS: The FRS discriminates the risk of long-term secondary events, including cardiac death, MI, and revascularization, in patients following PCI poorly, even among those presenting with acute coronary syndrome. The current study supports the development of novel secondary prevention risk models.

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