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Coronary Artery Disease: HELP
Articles by Chun Shing Kwok
Based on 13 articles published since 2008
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Between 2008 and 2019, Chun Shing Kwok wrote the following 13 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta-Analysis. 2017

Kotronias, Rafail A / Kwok, Chun Shing / George, Sudhakar / Capodanno, Davide / Ludman, Peter F / Townend, Jonathan N / Doshi, Sagar N / Khogali, Saib S / Généreux, Philippe / Herrmann, Howard C / Mamas, Mamas A / Bagur, Rodrigo. ·Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom. · Oxford University Clinical Academic Graduate School, Oxford University, Oxford, United Kingdom. · The Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom. · Cardio-Thoracic-Vascular Department, Ferrarotto Hospital University of Catania, Italy. · Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. · The Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom. · Cardiovascular Research Foundation, New York, NY. · Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. · Morristown Medical Center, Morristown, NJ. · Cardiology Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. · Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom rodrigobagur@yahoo.com. · Division of Cardiology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada. · Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. ·J Am Heart Assoc · Pubmed #28655733.

ABSTRACT: BACKGROUND: Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation. METHODS AND RESULTS: We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33-2.60; CONCLUSIONS: Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.

2 Review Review of early hospitalisation after percutaneous coronary intervention. 2017

Kwok, Chun Shing / Hulme, William / Olier, Ivan / Holroyd, Eric / Mamas, Mamas A. ·Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; University Hospital North Staffordshire, Stoke-on-Trent, UK; University of Manchester, Manchester, UK. Electronic address: shingkwok@doctors.org.uk. · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; University Hospital North Staffordshire, Stoke-on-Trent, UK. · University of Manchester, Manchester, UK. · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; University Hospital North Staffordshire, Stoke-on-Trent, UK; University of Manchester, Manchester, UK. ·Int J Cardiol · Pubmed #27839805.

ABSTRACT: BACKGROUND: Percutaneous coronary intervention (PCI) is the most common modality of revascularization in patients with coronary artery disease. Understanding the readmission rates and reasons for readmission after PCI is important because readmissions are a quality of care indicator, in addition to being a burden to patients and healthcare services. METHODS: A literature review was performed. Relevant studies are described by narrative synthesis with the use of tables to summarize study results. RESULTS: Data suggests that 30-day readmissions are not uncommon. The rate of readmission after PCI is highly influenced by the cohort and the healthcare system studied, with 30-day readmission rates reported to be between 4.7-% and 15.6%. Studies consistently report that a majority of readmissions within 30days are due to a cardiac-related disorders or complication-related disorders. Female sex, peripheral vascular disease, diabetes mellitus, renal failure and non-elective PCI are predictive of readmission. Studies also suggest that there is greater risk of mortality among patients who are readmitted compared to those who are not readmitted. CONCLUSION: Readmission after PCI is common and its rate is highly influenced by the type of cohort studied. There is clear evidence that majority of readmissions within 30days are cardiac related. While there are many predictors of readmission following PCI, it is not known whether targeting patients with modifiable predictors could prevent or reduce the rates of readmission.

3 Review Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis. 2016

Nagaraja, Vinayak / Ooi, Sze-Yuan / Nolan, James / Large, Adrian / De Belder, Mark / Ludman, Peter / Bagur, Rodrigo / Curzen, Nick / Matsukage, Takashi / Yoshimachi, Fuminobu / Kwok, Chun Shing / Berry, Colin / Mamas, Mamas A. ·Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia. · Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. · Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom. · The James Cook University Hospital, Middlesbrough, United Kingdom. · Queen Elizabeth Hospital, Birmingham, United Kingdom. · Division of Cardiology, Department of Medicine and Department of Epidemiology & Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada. · University Hospital Southampton & Faculty of Medicine University of Southampton, United Kingdom. · Division of Cardiology, Tokai University School of Medicine, Isehara, Japan. · Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom. · Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom mamasmamas1@yahoo.co.uk. ·J Am Heart Assoc · Pubmed #27986755.

ABSTRACT: BACKGROUND: Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta-analysis. METHODS AND RESULTS: A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random-effects meta-analysis was used to estimate the odds of adverse outcomes. Meta-regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty-eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI 0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50-0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR. CONCLUSION: CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score-based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.

4 Review Meta-Analysis of the Prognostic Impact of Anemia in Patients Undergoing Percutaneous Coronary Intervention. 2016

Kwok, Chun Shing / Tiong, Denise / Pradhan, Ashish / Andreou, Andreas Y / Nolan, James / Bertrand, Olivier F / Curzen, Nick / Urban, Philip / Myint, Phyo K / Zaman, Azfar G / Loke, Yoon K / Mamas, Mamas A. ·Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom. · Department of Medicine, Royal Preston Hospital, Preston, United Kingdom. · Department of Cardiology, Limassol General Hospital, Kato Polemidia, Cyprus. · Department of Cardiology, Quebec Heart-Lung Institute, Laval University, Laval, Canada. · Department of Cardiology, University of Southampton, Southampton, United Kingdom. · Department of Cardiology, La Tour Hospital, Geneva, Switzerland. · Epidemiology Group, University of Aberdeen, Aberdeen United Kingdom. · Department of Cardiology, Freeman Hospital, Newcastle University, Newcastle, United Kingdom. · Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom. · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk. ·Am J Cardiol · Pubmed #27342283.

ABSTRACT: Anemia is common in patients undergoing percutaneous coronary intervention (PCI), and current guidelines fail to offer recommendations for its management. This review aims to examine the relation between baseline anemia and mortality, major adverse cardiovascular events (MACE), and major bleeding in patients undergoing PCI. We searched MEDLINE and EMBASE for studies that evaluated mortality and adverse outcomes in anemic and nonanemic patients who underwent PCI. Data were collected on study design, participant characteristics, definition of anemia, follow-up, and adverse outcomes. Random effects meta-analysis of risk ratios was performed using inverse variance method. A total of 44 studies were included in the review with 230,795 participants. The prevalence of baseline anemia was 26,514 of 170,914 (16%). There was an elevated risk of mortality and MACE with anemia compared with no anemia-pooled risk ratio (RR) 2.39 (2.02 to 2.83), p <0.001 and RR 1.51 (1.34 to 1.71), p <0.001, respectively. The risk of myocardial infarction and bleeding with anemia compared with no anemia was elevated, pooled RR 1.33 (1.07 to 1.65), p = 0.01 and RR 1.97 (1.03 to 3.77), p <0.001, respectively. The risk of mortality per unit incremental decrease in hemoglobin (g/dl) was RR 1.19 (1.09 to 1.30), p <0.001 and the risk of mortality, MACE, and reinfarction per 1 unit incremental decrease in hematocrit (%) was RR 1.07 (1.05 to 1.10), p = 0.04, RR 1.09 (1.08 to 1.10) and RR 1.06 (1.03 to 1.10), respectively. The prevalence of anemia in contemporary cohorts of patients undergoing PCI is significant and is associated with significant increases in postprocedural mortality, MACE, reinfarction, and bleeding. The optimal strategy for the management of anemia in such patients remains uncertain.

5 Article Effect of Gender on Unplanned Readmissions After Percutaneous Coronary Intervention (from the Nationwide Readmissions Database). 2018

Kwok, Chun Shing / Potts, Jessica / Gulati, Martha / Alasnag, Mirvat / Rashid, Muhammad / Shoaib, Ahmad / Ul Haq, Muhammad Ayyaz / Bagur, Rodrigo / Mamas, Mamas Andreas. ·Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom. Electronic address: shingkwok@doctors.org.uk. · Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom. · Division of Cardiology, University of Arizona, Phoenix, Arizona. · Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia. · Division of Cardiology, London Health Sciences Centre, Department of Medicine, and Epidemiology & Biostatistics, Western University, London, Ontario, Canada. · Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom. ·Am J Cardiol · Pubmed #29448978.

ABSTRACT: Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs $12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes.

6 Article The Relationship of Body Mass Index to Percutaneous Coronary Intervention Outcomes: Does the Obesity Paradox Exist in Contemporary Percutaneous Coronary Intervention Cohorts? Insights From the British Cardiovascular Intervention Society Registry. 2017

Holroyd, Eric W / Sirker, Alex / Kwok, Chun Shing / Kontopantelis, Evangelos / Ludman, Peter F / De Belder, Mark A / Butler, Robert / Cotton, James / Zaman, Azfar / Mamas, Mamas A / Anonymous381080. ·Academic Department of Cardiology, Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom. · Department of Cardiology, University College London Hospitals and St. Bartholomew's Hospital, London, United Kingdom. · Academic Department of Cardiology, Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, United Kingdom. · Institute of Population Health, University of Manchester, Manchester, United Kingdom. · Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, United Kingdom. · The James Cook University Hospital, Middlesbrough, United Kingdom. · Department of Cardiology, The Heart and Lung Centre, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom. · Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom. · Academic Department of Cardiology, Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk. ·JACC Cardiovasc Interv · Pubmed #28683933.

ABSTRACT: OBJECTIVES: The aims of this study were to examine the relationship between body mass index (BMI) and clinical outcomes following percutaneous coronary intervention (PCI) and to determine the relevance of different clinical presentations requiring PCI to this relationship. BACKGROUND: Obesity is a growing problem, and studies have reported a protective effect from obesity compared with normal BMI for adverse outcomes after PCI. METHODS: Between 2005 and 2013, 345,192 participants were included. Data were obtained from the British Cardiovascular Intervention Society registry, and mortality data were obtained through the U.K. Office of National Statistics. Multiple logistic regression was performed to determine the association between BMI group (<18.5, 18.5 to 24.9, 25 to 30 and >30 kg/m RESULTS: At 30 days post-PCI, significantly lower mortality was seen in patients with elevated BMIs (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.80 to 0.93] 0.90 [95% CI: 0.82 to 0.98] for BMI 25 to 30 and >30 kg/m CONCLUSIONS: A paradox regarding the independent association of elevated BMI with reduced mortality after PCI is still evident in contemporary U.K. practice. This is seen in both stable and more acute clinical settings.

7 Article Choice of Stent for Percutaneous Coronary Intervention of Saphenous Vein Grafts. 2017

Iqbal, Javaid / Kwok, Chun Shing / Kontopantelis, Evangelos / de Belder, Mark A / Ludman, Peter F / Large, Adrian / Butler, Rob / Gamal, Amr / Kinnaird, Tim / Zaman, Azfar / Mamas, Mamas A / Anonymous3181104. ·From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.) · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.) · University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.) · Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom · The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.) · Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.F.L.) · Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.G., A.Z.) · and Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.). ·Circ Cardiovasc Interv · Pubmed #28404622.

ABSTRACT: BACKGROUND: There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society). METHODS AND RESULTS: Patients undergoing percutaneous coronary intervention to SVG in the United Kingdom from January 2006 to December 2013 were divided into 3 groups according to stent use: BMS, first-generation DES, and newer generation DES group. Study outcomes included in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality. Patients (n=15 003) underwent percutaneous coronary intervention to SVG in England and Wales during the study period. Of these, 38% received BMS, 15% received first-generation DES, and 47% received second-generation DES. The rates of in-hospital major adverse cardiovascular events were significantly lower in patients treated with second-generation DES (odds ratio, 0.51; 95% confidence interval, 0.38-0.68; CONCLUSIONS: Patients receiving second-generation DES for the treatment SVG disease have lower rates of in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality, compared with those receiving BMS.

8 Article Increased Radial Access Is Not Associated With Worse Femoral Outcomes for Percutaneous Coronary Intervention in the United Kingdom. 2017

Hulme, William / Sperrin, Matthew / Kontopantelis, Evangelos / Ratib, Karim / Ludman, Peter / Sirker, Alex / Kinnaird, Tim / Curzen, Nick / Kwok, Chun Shing / De Belder, Mark / Nolan, James / Mamas, Mamas A / Anonymous2841104. ·From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.) · Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.) · Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.) · St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.) · University Hospital of Wales, Cardiff, United Kingdom (T.K.) · Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.) · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.) · and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.). ·Circ Cardiovasc Interv · Pubmed #28196898.

ABSTRACT: BACKGROUND: The radial artery is increasingly adopted as the primary access site for cardiac catheterization because of patient preference, lower bleeding rates, cost effectiveness, and reduced risk of mortality in high-risk patient groups. Concerns have been expressed that operators/centers have become increasingly unfamiliar with transfemoral access. The aim of this study was to assess whether a change in access site practice toward transradial access nationally has led to worse outcomes in percutaneous coronary intervention procedures performed through the transfemoral access approach. METHODS AND RESULTS: Using the British Cardiovascular Intervention Society (BCIS) database, a retrospective analysis of 235 250 transfemoral access percutaneous coronary intervention procedures was undertaken in all 92 centers in England and Wales between 2007 and 2013. Recent femoral proportion and recent femoral volume were determined, and in-hospital vascular complications and 30-day mortality were evaluated. After case-mix adjustment, no independent association was observed between 30-day mortality for cases undertaken through the transfemoral access and center femoral proportion, the risk-adjusted odds ratio for recent femoral proportion was nonsignificant (odds ratio, 0.99; 95% confidence interval, 0.97-1.02; CONCLUSIONS: The outcome gains achieved by the national adoption of radial access are not associated with a loss of femoral proficiency, and centers should be encouraged to continue to adopt radial access as the default access site for percutaneous coronary intervention wherever possible in line with current best evidence.

9 Article 5-Fr sheathless transradial cardiac catheterization using conventional catheters and balloon assisted tracking; a new approach to downsizing. 2017

Mamas, Mamas A / George, Sudhakar / Ratib, Karim / Kwok, Chun Shing / Elkhazin, Abdelnasir / Sandhu, Kully / Stubbs, Julie / Luxford, Pamela / Nolan, James. ·Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK. Electronic address: mamasmamas1@yahoo.co.uk. · Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. · Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK. · Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, UK. ·Cardiovasc Revasc Med · Pubmed #27707595.

ABSTRACT: BACKGROUND: While the uptake of transradial access site is growing, there are concerns about associated radial injury. We report a feasibility study of a technique that enables both 5Fr diagnostic and PCI cases to be undertaken without an arterial sheath using conventional diagnostic and guide catheters with a modified balloon assisted tracking (BAT) technique. METHODS: We performed a prospective single center pilot study to assess the feasibility and effectiveness of sheathless radial artery access and BAT to perform coronary angiography and angioplasty using conventional 5 Fr diagnostic and guide catheters. We assessed for successful acquisition of good quality angiogram, completion of the angioplasty and access site complications. RESULTS: 5 Fr sheathless cardiac catheterization was undertaken in diagnostic (55%) and PCI cases (45%, all indications) in 60 consecutive patients (mean age 62.8±11.4years) using conventional catheters. The procedure was successfully performed via the radial artery using a sheathless technique with BAT in 93.3% of patients. All patients had a patent radial artery following removal of the Helix device and there were no recorded access site complications. CONCLUSIONS: Trans-radial cardiac catheterisation for diagnostic and PCI cases using 5F Sheathless catheters (whose outer diameter is smaller than a 3Fr introducer sheath) with BAT appears feasible and allows both cardiac catheterization for diagnostic and PCI indications to be undertaken safely using conventional catheters through the radial route, with high success rates.

10 Article Meta-Analysis of Percutaneous Coronary Intervention With Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left Anterior Descending Coronary Disease. 2016

Kinnaird, Tim / Kwok, Chun Shing / Narain, Aditya / Butler, Rob / Ossei-Gerning, Nicholas / Ludman, Peter / Moat, Neil / Anderson, Richard / Mamas, Mamas A. ·Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk. · Academic Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom. · Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom. · Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. · Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom. · Department of Cardiothoracic Surgery, Royal Brompton Hospital, United Kingdom. ·Am J Cardiol · Pubmed #27553097.

ABSTRACT: We performed a meta-analysis of the studies comparing the efficacy and safety of coronary artery bypass surgery against percutaneous coronary intervention with drug-eluting stents (PCI-DES) in patients with isolated LAD disease. Because of the limited randomized trial data, the optimal revascularization strategy for patients with isolated LAD disease remains uncertain. Using MEDLINE and EMBASE to source data, 11 studies (3 randomized trials and 8 cohort studies) including 5,044 participants were identified. No significant difference in mortality between PCI-DES and coronary artery bypass surgery (CABG; 111 of 2,122 [5.2%] and 120 of 2,574 [4.7%]; relative risk [RR] 1.23; 95% confidence interval [CI] 0.90 to 1.69) was detected. For MACE, PCI-DES was associated with significant increase in adverse events (RR 1.41; 95% CI 1.03 to 1.93, 8 studies, 4,230 participants). There were no significant differences in the risk of myocardial infarction (RR 0.86; 95% CI 0.58 to 1.26) or stroke (RR 2.36; 95% CI 0.54 to 10.43) between the 2 groups. There were 239 target vessel revascularization (TVR) events among 2,237 participants in the PCI-DES group (10.7%) and 145 TVR events among 2,793 participants in the CABG group (5.2%) with a significant increased risk of TVR in the PCI group (RR 2.52; 95% CI 1.69 to 3.77, 5,030 participants) compared with CABG. In conclusion, for patients with isolated disease of the LAD, meta-analysis of the available data suggests revascularization with a PCI-DES strategy offers similar mortality, MI, and stroke rates to CABG at the expense of increased TVR. Much of the data are derived from registries using first-generation DES, and further randomized trials with more contemporary platforms are needed.

11 Article Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Surgery. 2016

Iqbal, Javaid / Kwok, Chun Shing / Kontopantelis, Evangelos / de Belder, Mark A / Ludman, Peter F / Giannoudi, Marilena / Gunning, Mark / Zaman, Azfar / Mamas, Mamas A / Anonymous4000864. ·From the Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK (J.I.) · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK (C.S.K., M.A.M.) · Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands NHS Trust, UK (C.S.K., M.G., M.A.M.) · Farr Institute, University of Manchester, Manchester, UK (E.K., M.A.M.) · Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK (M.A.d.B.) · Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK (P.F.L.) · and Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK (M.G., A.Z.). ·Circ Cardiovasc Interv · Pubmed #27069103.

ABSTRACT: BACKGROUND: There are limited data on outcomes of patients with previous coronary artery bypass grafting (CABG) presenting with ST-segment-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PPCI). We report outcomes in patients with STEMI undergoing PPCI with or without previous CABG surgery in a large real-world, all-comer population. METHODS AND RESULTS: Clinical, demographic, procedural, and outcomes data were collected for all patients undergoing PPCI in England and Wales from January 2007 to December 2012. All-cause mortality at 30 days and 1 year were evaluated in the whole and a propensity-matched cohort. Of 79 295 patients with STEMI studied, 2658 (3.4%) patients had prior CABG, of whom 44% (n=1168) underwent PPCI to native vessels and 56% (n=1490) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. Patients with prior CABG (with primary PCI to native artery or graft) had higher mortality at 30 days (6.2% with PPCI to native artery, 6.1% with PPCI to bypass graft) than patients with no prior CABG (4.5%; P<0.001). However, after risk factor adjustments, there was no significant difference in outcomes. There were also no significant differences in 30-day mortality, in-hospital major adverse cardiovascular events, in-hospital stroke, and in-hospital bleeding in the propensity-matched population. CONCLUSIONS: A prior history of CABG in patients presenting with STEMI and undergoing PPCI does not independently confer additional risk of mortality, although it is a marker of other high-risk features.

12 Article Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study). 2015

Mamas, Mamas A / Fath-Ordoubadi, Farzin / Danzi, Gian B / Spaepen, Erik / Kwok, Chun Shing / Buchan, Iain / Peek, Niels / de Belder, Mark A / Ludman, Peter F / Paunovic, Dragica / Urban, Philip. ·Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, University of Keele, United Kingdom; Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. Electronic address: mamasmamas1@yahoo.co.uk. · Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom. · Division of Cardiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. · SBD Analytics, Hertstraat, Bekkevoort, Belgium. · Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. · Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine and Primary Care, University of Keele, United Kingdom; Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. · Cardiology Department, The James Cook University Hospital, Middlesbrough, United Kingdom. · Cardiology Department, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom. · European Medical and Clinical Division, Terumo Europe, Leuven, Belgium. · Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland. ·Am J Cardiol · Pubmed #26037294.

ABSTRACT: Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors.

13 Article Impact of age on the prognostic value of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. 2015

Kwok, Chun Shing / Anderson, Simon G / McAllister, Katherine S L / Sperrin, Matthew / O'Kane, Peter D / Keavney, Bernard / Nolan, James / Myint, Phyo Kyaw / Zaman, Azfar / Buchan, Iain / Ludman, Peter F / de Belder, Mark A / Mamas, Mamas A / Anonymous1140812. ·Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #25408308.

ABSTRACT: BACKGROUND: Around one third of patients undergoing percutaneous coronary intervention (PCI) have left ventricular (LV) dysfunction. Whilst the prevalence of LV dysfunction is known to increase with age, the prevalence of LV dysfunction in different age groups in the PCI setting is not known and the effect of age on the prognostic value of LV function in the PCI setting has not been examined. METHODS: The relationship between LV function and 30-day mortality in patients undergoing PCI in different age groups (<60 years, 60 to <70 years, 70 to <80 years and ≥80 years) was studied in 246,840 patients in the UK between 2006 and 2011. RESULTS: Prevalent LV dysfunction in patients undergoing PCI increased with age; 25,106/83,161 (30.2%: <60 years), 24,114/76,895 (31.4%: 60 to <70 years), 23,580/64,711 36.4% (70 to <80 years) and 9,851/22,073 (44.6%) in patients aged 80 or over (P < 0.0001). Poor LV function was independently associated with increased risk of 30-day mortality outcomes in all age groups (OR 5.65:95% CI 4.21-7.58, age <60 years; OR 5.07: 95% CI 3.91-6.57, age 60 to <70 years; OR 4.50: 95% CI 3.64-5.57, 70 to <80 years and OR 4.83:95% CI 3.79-6.15, age ≥80 years). CONCLUSIONS: Our analysis suggests that worsening LV function is an important independent predictor of worse 30-day mortality outcomes across all age groups and underscores the need for a measure of LV function in all patients for accurate risk stratification prior to PCI.