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Coronary Artery Disease: HELP
Articles by Debabrata Mukherjee
Based on 28 articles published since 2008
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Between 2008 and 2019, Debabrata Mukherjee wrote the following 28 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C / Halperin, Jonathan L / Levine, Glenn N / Al-Khatib, Sana M / Birtcher, Kim K / Bozkurt, Biykem / Brindis, Ralph G / Cigarroa, Joaquin E / Curtis, Lesley H / Fleisher, Lee A / Gentile, Federico / Gidding, Samuel / Hlatky, Mark A / Ikonomidis, John S / Joglar, José A / Pressler, Susan J / Wijeysundera, Duminda N. · ·J Thorac Cardiovasc Surg · Pubmed #27751237.

ABSTRACT: -- No abstract --

2 Guideline 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C. · ·J Am Coll Cardiol · Pubmed #27036918.

ABSTRACT: -- No abstract --

3 Guideline 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. 2013

Levine, Glenn N / Bates, Eric R / Blankenship, James C / Bailey, Steven R / Bittl, John A / Cercek, Bojan / Chambers, Charles E / Ellis, Stephen G / Guyton, Robert A / Hollenberg, Steven M / Khot, Umesh N / Lange, Richard A / Mauri, Laura / Mehran, Roxana / Moussa, Issam D / Mukherjee, Debabrata / Nallamothu, Brahmajee K / Ting, Henry H / Anonymous5470709 / Anonymous5480709 / Anonymous5490709. · ·Catheter Cardiovasc Interv · Pubmed #22065485.

ABSTRACT: -- No abstract --

4 Guideline 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. 2012

Levine, Glenn N / Bates, Eric R / Blankenship, James C / Bailey, Steven R / Bittl, John A / Cercek, Bojan / Chambers, Charles E / Ellis, Stephen G / Guyton, Robert A / Hollenberg, Steven M / Khot, Umesh N / Lange, Richard A / Mauri, Laura / Mehran, Roxana / Moussa, Issam D / Mukherjee, Debabrata / Nallamothu, Brahmajee K / Ting, Henry H / Anonymous640718 / Anonymous650718 / Anonymous660718. · ·Catheter Cardiovasc Interv · Pubmed #22328235.

ABSTRACT: -- No abstract --

5 Guideline ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. 2010

Mark, Daniel B / Berman, Daniel S / Budoff, Matthew J / Carr, J Jeffrey / Gerber, Thomas C / Hecht, Harvey S / Hlatky, Mark A / Hodgson, John McB / Lauer, Michael S / Miller, Julie M / Morin, Richard L / Mukherjee, Debabrata / Poon, Michael / Rubin, Geoffrey D / Schwartz, Robert S / Anonymous3330667. ·American College of Cardiology Foundation. ·Catheter Cardiovasc Interv · Pubmed #20687247.

ABSTRACT: -- No abstract --

6 Editorial Prior Coronary Revascularization and Risk of Noncardiac Surgery. 2017

Eagle, Kim A / Mukherjee, Debabrata. ·University of Michigan, Ann Arbor, Michigan. Electronic address: keagle@umich.edu. · Texas Tech University Health Sciences Center, El Paso, Texas. ·JACC Cardiovasc Interv · Pubmed #28161259.

ABSTRACT: -- No abstract --

7 Editorial Peripheral arterial disease: implications beyond the peripheral circulation. 2013

Paraskevas, Kosmas I / Mukherjee, Debabrata / Whayne, Thomas F. ·1Vascular surgeon, Athens, Greece. ·Angiology · Pubmed #23221278.

ABSTRACT: Peripheral arterial disease (PAD) affects a considerable percentage of the population. The manifestations of this disease are not always clinically overt. As a result, PAD remains underdiagnosed and undertreated. PAD is not just a disease of the peripheral arteries, but also an indication of generalized vascular atherosclerosis. PAD patients also have a high prevalence of other arterial diseases, such as coronary/carotid artery disease and abdominal aortic aneurysms. PAD is also a predictor of increased risk of lung and other cancers. The most often used examination for the establishment of the diagnosis of PAD, the ankle-brachial pressure index (ABPI), is also a predictor of generalized atherosclerosis, future cardiovascular events and cardiovascular mortality. Several markers that have been linked with PAD (e.g. C-reactive protein, serum bilirubin levels) may also have predictive value for other conditions besides PAD (e.g. kidney dysfunction). The management of PAD should therefore not be restricted to the peripheral circulation but should include measurements to manage and decrease the systemic atherosclerotic burden of the patient.

8 Editorial Chronic total occlusions in non-infarct-related arteries. 2012

Mukherjee, Debabrata / Roffi, Marco. · ·Eur Heart J · Pubmed #22285580.

ABSTRACT: -- No abstract --

9 Editorial Second-generation drug-eluting stents and the continuous need for rapidly available real-world data. 2009

Mukherjee, Debabrata / Moliterno, David J. · ·JACC Cardiovasc Interv · Pubmed #20129550.

ABSTRACT: -- No abstract --

10 Editorial Antithrombotics for PCI: an indigenous direct thrombin inhibitor (DTI) makes the cut. 2008

Mukherjee, Debabrata. · ·Indian Heart J · Pubmed #19242003.

ABSTRACT: -- No abstract --

11 Editorial Improving adherence to medications--can we make this horse drink? 2008

Mukherjee, Debabrata. · ·Am Heart J · Pubmed #18371463.

ABSTRACT: -- No abstract --

12 Review Duration of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation in Diabetic and Non-Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2018

Sharma, Abhishek / Garg, Aakash / Elmariah, Sammy / Drachman, Douglas / Obiagwu, Chukwudi / Vallakati, Ajay / Sharma, Samin K / Lavie, Carl J / Mukherjee, Debabrata / Waksman, Ron / Stefanini, Giulio G / Feres, Fausto / Marmur, Jonathan D / Helft, Gérard. ·Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Institute of Cardiovascular Science and Technology, Brooklyn, NY, USA. Electronic address: abhisheksharma4mamc@gmail.com. · Institute of Cardiovascular Science and Technology, Brooklyn, NY, USA; Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA. · Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, USA. · Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Department of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, NY, USA. · Division of Cardiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA. · Department of Cardiovascular Medicine, Heart & Vascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA. · Division of Cardiology, Texas Tech University, El Paso, TX, USA. · Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA. · Cardiovascular Department, Humanitas Research Hospital, Rozzano, Milan, Italy. · Instituto Dante Pazzanese de Cardiologia, Ave Dante Pazzanense, 500, Ibirapuera, São Paulo, São Paulo, Brazil. · Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA. · Institut de Cardiologie, Hôpital Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, boulevard de l'Hôpital, Paris, France; Institute of Cardiometabolism and Nutrition, Hôpital Pitié-Salpétrière, Paris, France. ·Prog Cardiovasc Dis · Pubmed #29277295.

ABSTRACT: BACKGROUND: Diabetic patients account for an increasing number of patients undergoing percutaneous coronary intervention (PCI). However, diabetes mellitus (DM) is associated with increased residual platelet activity during dual antiplatelet treatment (DAPT) and DM patients have worse clinical outcomes after PCI as compared to non-DM. OBJECTIVE: To evaluate efficacy and safety of short duration DAPT (S-DAPT) and long duration DAPT (L-DAPT) after drug eluting stent (DES) implantation in DM and non-DM patients. METHODS: We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the effect of S-DAPT versus L-DAPT after DES implantation in DM and non-DM patients. Efficacy endpoints were all-cause mortality, cardiac mortality, myocardial infarction (MI), stent thrombosis (ST), target vessel revascularization (TVR), and composite end point of net adverse clinical events (NACE) (all-cause mortality, cardiac mortality, MI, ST, TVR, stroke, major bleeding). Safety endpoints were major bleeding and stroke. Event rates were compared using a forest plot of relative risk using a random effects model. RESULTS: We included eight RCTs that randomized 28,318 patients to S-DAPT versus L-DAPT (8234 DM and 20,084 non-DM). S-DAPT was associated with an increased rate of ST in non-DM patients [3.67 (2.04, 6.59)]. There was no significant difference in the rate of all-cause mortality, cardiac mortality, ST, MI, TVR, major bleeding, stroke and NACE with S-DAPT and L-DAPT in DM patients [1.19 (0.72-1.95); 1.25 (0.69, 2.25); 1.52 (0.70, 3.29); 1.33 (0.88, 2.01); 1.39 (0.89, 2.17); 0.92 (0.19, 4.42); 0.98 (0.29, 3.28); and 0.94 (0.57, 1.54) respectively]. Further, there was no significant difference in the rate of all-cause mortality, cardiac mortality, MI, TVR, major bleeding, stroke and NACE with S-DAPT and L-DAPT in non-DM patients [0.93 (0.58, 1.48); 0.75 (0.42, 1.35); 1.52 (0.81, 2.83); 0.99 (0.71, 1.39); 0.72 (0.28, 1.84); 1.01 (0.40, 2.56); and 1.01 (0.77, 1.32) respectively]. CONCLUSION: Compared to L-DAPT, S-DAPT was associated with significant increase in rate of ST in non-DM patients. Duration of DAPT had no significant impact on rates of all-cause mortality, cardiac mortality, MI, ST and TVR among DM patients.

13 Review Outcomes of Saphenous Vein Graft Intervention With and Without Embolic Protection Device: A Comprehensive Review and Meta-Analysis. 2017

Paul, Timir K / Bhatheja, Samit / Panchal, Hemang B / Zheng, Shimin / Banerjee, Subhash / Rao, Sunil V / Guzman, Luis / Beohar, Nirat / Zhao, David / Mehran, Roxana / Mukherjee, Debabrata. ·From the Division of Cardiology, Department of Internal Medicine (T.K.P., H.B.P.) and Department of Biostatistics and Epidemiology, College of Public Health (S.Z.), East Tennessee State University, Johnson City · The Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.B., R.M.) · VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas (S.B.) · The Duke Clinical Research Institute, Durham, NC (S.V.R.) · Virginia Commonwealth University, Richmond (L.G.) · Nirat Beohar, Columbia University Division of Cardiology at the Mount Sinai Medical Center, Miami Beach, FL (N.B.) · Wake Forest University, Winston-Salem, NC (D.Z.) · and Division of Cardiology, Department of Internal Medicine, Texas Tech University, El Paso (D.M.). ·Circ Cardiovasc Interv · Pubmed #29246912.

ABSTRACT: BACKGROUND: Current guidelines give a class I recommendation to use of embolic protection devices (EPD) for saphenous vein graft (SVG) intervention; however, studies have shown conflicting results. The objective of this meta-analysis is to compare all-cause mortality, major adverse cardiovascular events, myocardial infarction (MI), or target vessel revascularization in SVG intervention with and without EPD. METHODS AND RESULTS: Literature was searched through October 2016. Eight studies (n=52 893) comparing SVG intervention performed with EPD (n=11 506) and without EPD (n=41 387) were included. There was no significant difference in all-cause mortality (odds ratio [OR], 0.79; confidence interval [CI], 0.55-1.12; CONCLUSIONS: This study including 52 893 patients suggests no apparent benefit in routine use of EPD during SVG intervention in the contemporary real-world practice. Further randomized clinical trials are needed in current era to evaluate long-term outcomes in routine use of EPD, and meanwhile, current guideline recommendations on EPD use should be revisited.

14 Review Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel intervention-meta-analysis of randomized trials and risk prediction modeling study using observational data. 2017

Chatterjee, Saurav / Kundu, Amartya / Mukherjee, Debabrata / Sardar, Partha / Mehran, Roxana / Bashir, Riyaz / Giri, Jay / Abbott, Jinnette D. ·Division of Cardiology, St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System, New York, New York. · Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. · Division of Cardiology, Texas Tech University Health Sciences Center, El Paso, Texas. · Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah. · Director of Interventional Research, Icahn School of Medicine, Mount Sinai Health System, New York, New York. · Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania. · Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Warren Alpert School of Medicine and Brown University, Rhode Island Hospital, Providence, Rhode Island. ·Catheter Cardiovasc Interv · Pubmed #28112470.

ABSTRACT: OBJECTIVES: Ascertaining risk of contrast induced acute kidney injury (CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing multi-vessel percutaneous coronary intervention (MV-PCI). BACKGROUND: Complete revascularization may improve outcomes in STEMI patients with multi-vessel disease. However, a practice of MV-PCI may be associated with a higher risk of CI-AKI. We aimed to evaluate the risk of CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a validated risk score. METHODS: We searched PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI and infarct-related artery (IRA) only PCI during index hospitalization. A random effects model was used to estimate the risk ratio (RR) and respective 95% confidence intervals (CI). We queried the Nationwide Inpatient Sample (NIS) to assess the ability of the Mehran risk score to accurately predict the incidence of CI-AKI in patients undergoing MV-PCI. RESULTS: Four randomized studies (N = 1,602) were included in the final analysis. The risk of CI-AKI was low and no difference was observed with MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57; P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI for STEMI patients in the NIS. The Mehran risk score accurately discriminated 78% of the patients who developed CI-AKI in this cohort (c-statistic of 0.78, P = 0.002). CONCLUSIONS: MV-PCI in STEMI is not associated with a higher risk of CI-AKI and the Mehran risk score can identify patients at higher risk for this complication. © 2017 Wiley Periodicals, Inc.

15 Review Increased Exercise Favorably Modifies Coronary Artery Disease and Peripheral Arterial Disease Outcomes. 2016

Whayne, Thomas F / Mukherjee, Debabrata. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA 326 Wethington Building 900 South Limestone Street Lexington, KY 40536-0200, USA. twhayn0@uky.edu. ·Curr Vasc Pharmacol · Pubmed #27456103.

ABSTRACT: Exercise therapy, especially when supervised on-site in a clinical facility or directed off-site for a home-based program, is an essential component of the management of coronary artery disease (CAD) and peripheral arterial disease (PAD). In the case of both atherosclerotic diseases, it can decrease adverse cardiovascular (CV) events. There has been a recent push toward invasive management of both CAD and PAD but accumulating clinical experience has shown the limitation of invasive management and emphasized the importance of medications, CV risk reduction, conditioning, and exercise, especially when supervised. Exercise results in increased peak oxygen consumption (V02), improvement of wellestablished CV risk factors such as plasma lipids, and an improvement in indicators of inflammation and of various metabolic factors. Fortunately, there is generally good third-party coverage of medications and vascular interventions but unfortunately, poor insurance coverage for supervised or directed exercise programs for which significant patient benefit has been established.

16 Review 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. 2016

Levine, Glenn N / Bates, Eric R / Bittl, John A / Brindis, Ralph G / Fihn, Stephan D / Fleisher, Lee A / Granger, Christopher B / Lange, Richard A / Mack, Michael J / Mauri, Laura / Mehran, Roxana / Mukherjee, Debabrata / Newby, L Kristin / O'Gara, Patrick T / Sabatine, Marc S / Smith, Peter K / Smith, Sidney C. ·Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ACC/AHA Representative. Evidence Review Committee Chair. American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. American Association for Thoracic Surgery/Society of Thoracic Surgeons Representative. Society for Cardiovascular Angiography and Interventions Representative. ·Circulation · Pubmed #27026020.

ABSTRACT: -- No abstract --

17 Review Women, the menopause, hormone replacement therapy and coronary heart disease. 2015

Whayne, Thomas F / Mukherjee, Debabrata. ·aDivision of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky bDivision of Cardiovascular Medicine, Texas Tech University HSC, and Paul Foster School of Medicine, El Paso, Texas, USA. ·Curr Opin Cardiol · Pubmed #25695898.

ABSTRACT: PURPOSE OF REVIEW: Cardiovascular disease considerations are associated with the menopause. Despite a misconception that women have a minimal risk for coronary heart disease (CHD), it is the major cause of female deaths. This review highlights issues of hormone replacement therapy (HRT) and CHD in women. RECENT FINDINGS: A woman under age 60, who suffers a myocardial infarction (MI), has a 2-year post-MI mortality of 28.9%; it is 19.6% in men. CHD and MI in women are subtle. In addition, female mortality from CHD increases after the menopause. The increased inflammatory risk factor status of women plays a role in development of atherosclerosis, before and after the menopause. Until after the menopause, women overall have a lower CHD mortality rate. Menopause is associated with unique symptoms, especially vasomotor ones; preexisting cardiovascular disease further exacerbates problems associated with the menopause. Use of HRT after the menopause is a major issue. Early menopause at age 39 years or younger and late menopause at age 56 years or older increase cardiovascular risk. HRT should not be prescribed for cardiovascular risk prevention, but when less than 10 years from menopause at a normal age, women can be reassured that cardiovascular risk from HRT is very low. SUMMARY: Prescription of HRT should never be made only for cardiovascular risk reduction. However, when symptom-related and other indications are present, HRT is appropriate and well tolerated in the early years after menopause with onset at a normal age.

18 Review PAR-1 antagonists: current state of evidence. 2013

Chatterjee, Saurav / Sharma, Abhishek / Mukherjee, Debabrata. ·Maimonides Medical Center, 864 49th Street Apt C11, Brooklyn, NY 11220, USA. sauravchatterjeemd@gmail.com ·J Thromb Thrombolysis · Pubmed #22644721.

ABSTRACT: Vorapaxar (SCH 530348) and atopaxar (E5555) are oral protease-activated receptor-1 (PAR-1) antagonists with high bioavailability. They inhibits thrombin induced platelet aggregation by competitively inhibiting PAR-1. We systematically evaluated the evidence for the efficacy and safety of all PAR-1 antagonists as well as for the individual drugs vorapaxar and atopaxar in different databases-PubMed, EMBASE, Scopus, and Cochrane register of Controlled Clinical Trials (CENTRAL).We selected randomized controlled trials of PAR-1 antagonists that reported on cardiovascular mortality as a clinical outcome. The random-effects Mantel-Haenszel model was used to evaluate the effect of PAR-1 antagonists on cardiovascular mortality. Seven trials were selected (N = 42,355) for analysis. PAR-1 antagonists as a class, as well as individually, were associated with a non-significant numerically lower risk of cardiovascular mortality than that seen with agents used in the control group; RR, 0.93; 95% CI, 0.83-1.04; P = 0.20). No heterogeneity was noted. However, PAR-1 antagonists also appeared to increase the risk of bleeding significantly. PAR-1 antagonists appear to be associated with some reduction in the risk of cardiovascular mortality; however the significantly higher bleeding risk noted with PAR-1 antagonists appear to mandate a very careful selection of patients that may benefit without a substantially increased risk of bleeds.

19 Review Optimal medical therapy for coronary artery disease in 2011 - perspectives from the STICH Trial. 2011

Whayne, Thomas F / Saha, Sibu P / Quevedo, Karla / Mukherjee, Debabrata. ·Divisions of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA. twhayn0@uky.edu ·Cardiovasc Hematol Agents Med Chem · Pubmed #21902655.

ABSTRACT: Medical, percutaneous interventional, and surgical treatments for the management of coronary heart disease have progressed markedly during the past decade. There is evidence to suggest that for patients with stable coronary heart disease optimal medical therapy is equal in effectiveness for lowering the risk of major cardiovascular events, such as cardiovascular death, myocardial infarction, and stroke, as are revascularization procedures, such as coronary artery bypass grafting or percutaneous coronary intervention. The landmark Surgical Treatment for Ischemic Heart Failure (STICH) trial found no significant difference between medical therapy alone and medical therapy plus coronary artery bypass grafting with respect to the primary end point of death from any cause (all-cause mortality). However, secondary outcomes showed fewer deaths from cardiovascular causes in the surgical group versus the medical group. Medical therapy has improved over time, as have surgical techniques including myocardial preservation, and both approaches have their place, especially since chest pain relief and quality of life may benefit more in some cases by revascularization. Certainly, coronary artery bypass grafting has general acceptance for three-vessel coronary heart disease, and percutaneous coronary artery intervention is the standard of care for the involved artery in acute ST-segment elevation myocardial infarction when the intervention can be accomplished rapidly. Medical management includes lifestyle changes that benefit coronary heart disease, drug therapy to improve prognosis, and drug therapy to improve symptoms. The key to clinical management is the selection of the procedure and/or medical management strategy that is in the best interest of the individual cardiovascular patient. In addition, discussing with patients their options and considering what best fits their wishes is especially critical when there is no clear-cut best strategy. Continued collaboration between cardiologists concentrating on medical approaches with interventionists and cardiac surgeons (heart team approach) is essential for optimal management for each individual patient.

20 Review Contemporary management of concomitant carotid and coronary artery disease. 2011

Venkatachalam, Sridhar / Gray, Bruce H / Mukherjee, Debabrata / Shishehbor, Mehdi H. ·Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA. ·Heart · Pubmed #21156674.

ABSTRACT: The best approach to the management of concomitant severe carotid and coronary artery disease remains unanswered. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend carotid endarterectomy (CEA) in asymptomatic carotid stenosis of ≥ 80% either prior to or combined with coronary artery bypass surgery (CABG). Currently, there is no consensus as to which surgical approach is superior. More recently, carotid artery stenting (CAS) prior to CABG is emerging as an alternative option with promising results in asymptomatic patients considered 'high risk' for CEA. A <3% composite event rate has been set as a benchmark for isolated CAS or CEA in asymptomatic patients by the ACC/AHA; however, most CEA or CAS studies in patients requiring concomitant CABG have shown event rates ranging from 10-12%. This review examines the available data on carotid revascularisation in relation to CABG surgery to aid in the risk-benefit decision analysis in this controversial area.

21 Review Drug-eluting stents versus bare-metal stents in saphenous vein graft interventions: a systematic review and meta-analysis. 2010

Wiisanen, Matthew E / Abdel-Latif, Ahmed / Mukherjee, Debabrata / Ziada, Khaled M. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone Street, Lexington, KY 40536-0200, USA. ·JACC Cardiovasc Interv · Pubmed #21232720.

ABSTRACT: OBJECTIVES: We sought to review the published data and perform a meta-analysis to reach robust conclusions in the comparison between bare-metal stents (BMS) and drug-eluting stents (DES) in saphenous vein graft (SVG) percutaneous coronary interventions (PCIs). BACKGROUND: Drug-eluting stents are superior to BMS in reducing major adverse cardiac events (MACE) after PCI in native coronary arteries. However, studies comparing BMS with DES in PCI of SVG have had mixed results, probably due to smaller numbers and the nonrandomized nature of most of them. METHODS: The published reports search identified 4 randomized controlled trials and 19 cohort studies comparing BMS with DES in SVG interventions. Clinical end point data were abstracted and analyzed in aggregate and in subgroup analyses with random-effects model. RESULTS: Patients receiving DES had a lower risk of mortality (odds ratio [OR]: 0.75; confidence interval [CI]: 0.59 to 0.96), target lesion revascularization (TLR) (OR: 0.57; CI: 0.40 to 0.82), target vessel revascularization (TVR) (OR: 0.56; CI: 0.40 to 0.77), and MACE (OR: 0.61; CI: 0.42 to 0.79). Drug-eluting stent use resulted in a significant absolute risk reduction in TLR (-0.07; CI: -0.11 to -0.03), TVR (-0.10; CI: -0.15 to -0.05), and MACE (-0.12; CI: -0.18 to -0.06). There was no significant difference between the groups in recurrent myocardial infarction (OR: 0.99; CI: 0.65 to 1.51) or stent thrombosis (OR: 0.78; CI: 0.40 to 1.52). CONCLUSIONS: In this meta-analysis comparing DES with BMS use in PCI of SVG lesions, DES use was associated with improved mortality, MACE, TLR, and TVR. There was no evidence of increased risk of myocardial infarction or stent thrombosis.

22 Review Drug-eluting stents in patients with end-stage renal disease: meta-analysis and systematic review of the literature. 2010

Abdel-Latif, Ahmed / Mukherjee, Debabrata / Mesgarzadeh, Paymon / Ziada, Khaled M. ·Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky 40536-0200, USA. ·Catheter Cardiovasc Interv · Pubmed #20506492.

ABSTRACT: OBJECTIVE: The study sought to examine the total weight of evidence regarding the use of drug eluting (DES) and bare metal stents (BMS) in patients with end stage renal disease (ESRD). BACKGROUND: The potential superiority of DES over BMS in reducing target lesion or vessel revascularization (TLR or TVR) in patients with ESRD on dialysis has not been established. Small studies comparing DES to BMS in this population have yielded inconclusive results mainly due to the small sample size. METHODS: We searched MEDLINE, EMBASE, Science Citation Index, CINAHL, and the Cochrane CENTRAL database of controlled clinical trials (December 2009) for controlled trials comparing DES to BMS in ESRD patients. We conducted a fixed-effects meta-analysis across seven eligible studies (n = 869 patients). RESULTS: Compared with BMS-treated patients, DES-treated patients had significantly lower TLR/TVR (OR 0.55 CI: 0.39-0.79) and major adverse cardiac events (MACE) (OR 0.54; CI: 0.40-0.73). The absolute risk reduction (ARR) with DES in TLR/TVR was -0.09 (CI: -0.14 to -0.04; NNT 11) and in MACE was -0.13 (CI: -0.19 to -0.07; NNT 8). A trend towards lower incidence of all cause mortality was also noted with DES (OR 0.68; CI: 0.45-1.01). No significant differences were noted between both groups in the relative or absolute risk of myocardial infarction. CONCLUSION: The use of DES in patients with ESRD is safe and yields significant reduction in the risk of TLR/TVR and MACE. Larger randomized studies are needed to confirm the results of this meta-analysis and establish the appropriate stent choice in this high risk population.

23 Review Emerging P2Y12 receptor antagonists: role in coronary artery disease. 2010

Oliphant, Carrie S / Doby, J Bradford / Blade, Crystal L / Das, Kanak / Mukherjee, Debabrata / Das, Pranab. ·Department of Pharmacy, Methodist University Hospital, University of Tennessee College of Pharmacy, Memphis, TN 38104, USA. ·Curr Vasc Pharmacol · Pubmed #19485932.

ABSTRACT: The use of oral antiplatelet therapy in reducing vascular events has been extensively studied. Currently available oral antiplatelet agents include aspirin and the thienopyridine P2Y12 receptor antagonists. These classes are combined frequently in the setting of acute coronary syndrome and percutaneous coronary intervention (PCI). Resistance to either or both of these agents is a major concern, as antiplatelet resistance has been linked to an increase in thrombotic events and worse clinical outcomes. As a result, there is a need for newer, more effective antiplatelet agents to address the limitations of currently available therapy. Prasugrel, a third generation thienopyridine, has been approved by both the FDA and European Commission. Two additional P2Y12 agents, ticagrelor and cangrelor are in advanced stages of development. The possible advantages of prasugrel over clopidogrel include a faster onset of action, reduced inter-patient variability and more potent platelet inhibition. Ticagrelor is an oral reversible P2Y12 antagonist with greater platelet inhibition compared with clopidogrel. Cangrelor is being developed as an intravenous P2Y12 antagonist with a very fast onset and offset, which may offer advantages particularly in the setting of coronary intervention. These emerging antiplatelet agents may offer advantages such as faster onset of action, greater potency and reversibility of platelet inhibition. This article summarizes the available clinical data on the upcoming P2Y12 antiplatelet agents in the treatment of coronary artery disease.

24 Review Coronary, peripheral and cerebrovascular disease: a complex relationship. 2008

Shah, Amber M / Banerjee, Teesta / Mukherjee, Debabrata. ·Department of Medicine, University of Kentucky, Lexington, KY 40536-0200, USA. ·Herz · Pubmed #19066743.

ABSTRACT: Atherosclerosis is a diffuse process that may affect different vascular beds with considerable overlap between coronary, cerebrovascular and peripheral arterial disease. These conditions are related to similar predisposing risk factors and genetic predisposition. Presence of atherosclerosis at one arterial site should prompt the clinician to assess for an involvement, symptomatic or asymptomatic, at other arterial distributions. Patients with peripheral or cerebrovascular disease often receive less than optimal secondary preventive therapy than those with coronary artery disease. It is imperative that these individuals with noncoronary atherosclerotic disease be also treated aggressively to reduce the high adverse cardiovascular event rate reported in these patients.

25 Clinical Trial Prognostic implications of creatine kinase-MB elevation after percutaneous coronary intervention: results from the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry. 2011

Lindsey, Jason B / Kennedy, Kevin F / Stolker, Joshua M / Gilchrist, Ian C / Mukherjee, Debabrata / Marso, Steven P / Pencina, Michael J / Kleiman, Neal S / Cohen, David J. ·Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO 64111, USA. ·Circ Cardiovasc Interv · Pubmed #21972402.

ABSTRACT: BACKGROUND: Creatine kinase-MB (CK-MB) elevation after percutaneous coronary intervention (PCI) has been associated with increased risk for mortality. Although most studies have defined periprocedural myocardial infarction (pMI) as an elevation in CK-MB >3× upper limit of normal (ULN), use of different CK-MB assays and variation in site-specific definitions of the ULN may limit the value of such relative thresholds. METHODS AND RESULTS: We used data from the multicenter Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry to examine the impact of variations in site-specific thresholds for CK-MB elevation on the incidence of pMI as well as the relationship between absolute peak levels of CK-MB after PCI and 1-year mortality. The study cohort consisted of 6347 patients who underwent nonemergent PCI and had normal CK-MB at baseline. Across the 59 study centers, the ULN for CK-MB ranged from 2.6 to 10.4 ng/mL (median, 5.0 ng/mL), and there was an inverse relationship between the site-specific ULN and the incidence of pMI (defined as CK-MB elevation >3× ULN). Although any postprocedure elevation of CK-MB was associated with an adverse prognosis, in categorical analyses, only CK-MB ≥50 ng/mL was independently associated with increased 1-year mortality (hazard ratio, 4.71; 95% confidence interval, 2.42 to 9.13; P<0.001). Spline analysis using peak CK-MB as a continuous variable suggested a graded, nonlinear relationship with 1-year mortality, with an inflection point at ≈30 ng/mL. CONCLUSIONS: Among unselected patients undergoing PCI, there is a graded relationship between CK-MB elevation after PCI and 1-year mortality that is particularly strong for large CK-MB elevations (>30 to 50 ng/mL). Future studies that include pMI as a clinical end point should consider using a core laboratory to assess CK-MB (to ensure consistency) and raising the threshold for defining pMI above current levels (to enhance clinical relevance).

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