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Coronary Artery Disease: HELP
Articles by Srihari S. Naidu
Based on 17 articles published since 2008
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Between 2008 and 2019, Srihari S. Naidu wrote the following 17 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology-Association canadienne de cardiologie d'intervention). 2016

Naidu, Srihari S / Aronow, Herbert D / Box, Lyndon C / Duffy, Peter L / Kolansky, Daniel M / Kupfer, Joel M / Latif, Faisal / Mulukutla, Suresh R / Rao, Sunil V / Swaminathan, Rajesh V / Blankenship, James C. ·Division of Cardiology, Winthrop University Hospital, Mineola, New York. ssnaidu@winthrop.org. · Warren Alpert Medical School of Brown University, Cardiovascular Institute, Providence, RI. · West Valley Medical Center, Caldwell, ID. · FirstHealth of the Carolinas, Pinehurst, NC. · Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · University of Illinois School of Medicine-Peoria, Peoria, IL. · University of Oklahoma and VA Medical Center, Oklahoma City, OK. · University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA. · Duke University Medical Center, Durham, NC. · Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, NY. · Geisinger Medical Center, Danville, PA. ·Catheter Cardiovasc Interv · Pubmed #27137680.

ABSTRACT: -- No abstract --

2 Editorial SCAI position statement concerning coverage policies for percutaneous coronary interventions based on the appropriate use criteria. 2016

Klein, Lloyd W / Blankenship, James C / Kolansky, Daniel M / Dean, Larry S / Naidu, Srihari S / Chambers, Charles E / Duffy, Peter L / Anonymous2810861. ·Rush Medical College, Chicago, IL. · Geisinger Medical Center, Danville, PA. · University of Pennsylvania School of Medicine, Philadelphia, PA. · University of Washington, Seattle, WA. · Winthrop University Hospital, Mineola, NY. · Hershey Medical Center, Hershey, PA. · FirstHealth of the Carolinas, Reid Heart Center, Pinehurst, NC. ·Catheter Cardiovasc Interv · Pubmed #26968441.

ABSTRACT: -- No abstract --

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

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

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

4 Review The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel. 2017

Bangalore, Sripal / Bezerra, Hiram G / Rizik, David G / Armstrong, Ehrin J / Samuels, Bruce / Naidu, Srihari S / Grines, Cindy L / Foster, Malcolm T / Choi, James W / Bertolet, Barry D / Shah, Atman P / Torguson, Rebecca / Avula, Surendra B / Wang, John C / Zidar, James P / Maksoud, Aziz / Kalyanasundaram, Arun / Yakubov, Steven J / Chehab, Bassem M / Spaedy, Anthony J / Potluri, Srini P / Caputo, Ronald P / Kondur, Ashok / Merritt, Robert F / Kaki, Amir / Quesada, Ramon / Parikh, Manish A / Toma, Catalin / Matar, Fadi / DeGregorio, Joseph / Nicholson, William / Batchelor, Wayne / Gollapudi, Raghava / Korngold, Ethan / Sumar, Riyaz / Chrysant, George S / Li, Jun / Gordon, John B / Dave, Rajesh M / Attizzani, Guilherme F / Stys, Tom P / Gigliotti, Osvaldo S / Murphy, Bruce E / Ellis, Stephen G / Waksman, Ron. ·Department of Medicine, New York University School of Medicine, New York, New York. Electronic address: sripalbangalore@gmail.com. · Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Department of Medicine, HonorHealth and the HonorHealth Heart Group, Scottsdale, Arizona. · Department of Medicine, University of Colorado, Denver, Colorado. · Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Medicine, Westchester Medical Center, Valhalla, New York. · Department of Medicine, North Shore University Hospital, Manhasset, New York. · Department of Medicine, Tennova Healthcare, Knoxville, Tennessee. · Department of Medicine, Baylor Heart and Vascular Hospital, Dallas, Texas. · Department of Medicine, North Mississippi Medical Center, Tupelo, Mississippi. · Department of Medicine, University of Chicago, Chicago, Illinois. · Department of Medicine, MedStar Washington Hospital Center, Washington, DC. · Department of Medicine, Advocate Christ Hospital and Medical Center, Oak Lawn, Illinois. · Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland. · Department of Medicine, UNC/Rex Healthcare, Raleigh, North Carolina. · Department of Medicine, Cardiovascular Research Institute of Kansas, Kansas City, Kansas. · Department of Medicine, Seattle Heart and Vascular Institute, Seattle, Washington. · Department of Medicine, OhioHealth, Columbus, Ohio. · Department of Medicine, University of Kansas, Kansas City, Kansas. · Department of Medicine, Missouri Heart Center, Columbia, Missouri. · Department of Medicine, The Heart Hospital Baylor Plano, Plano, Texas. · Department of Medicine, St. Joseph's/Trinity Hospital, Syracuse, New York. · Department of Medicine, DMC Heart Hospital/Wayne State University, Detroit, Michigan. · Department of Medicine, Mercy Hospital and Clinic, Springfield, Missouri. · Department of Medicine, Heart & Vascular Institute, Detroit, Michigan. · Department of Medicine, Miami Cardiac & Vascular Institute, Baptist Health, Miami, Florida. · Department of Medicine, Columbia University Medical Center, New York, New York. · Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · Department of Medicine, University of South Florida, Tampa, Florida. · Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey. · Department of Medicine, York Hospital, York, Pennsylvania. · Department of Medicine, Tallahassee Memorial Hospital/Florida State University, Tallahassee, Florida. · Department of Medicine, San Diego Cardiac Center, San Diego, California. · Department of Medicine, Providence St. Vincent Medical Center, Portland, Oregon. · Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. · Department of Medicine, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma. · Department of Medicine, Geisinger Holy Spirit, Harrisburg, Pennsylvania. · Department of Medicine, Sanford Health, Sioux Falls, South Dakota. · Department of Medicine, Seton Heart Institute, Austin, Texas. · Department of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas. · Department of Medicine, Cleveland Clinic, Cleveland, Ohio. ·JACC Cardiovasc Interv · Pubmed #29216997.

ABSTRACT: Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.

5 Review Hemodynamic Support Devices for Complex Percutaneous Coronary Intervention. 2016

Alkhatib, Basil / Wolfe, Laura / Naidu, Srihari S. ·Division of Cardiology, Winthrop University Hospital, 120 Mineola Boulevard, Suite 500, Mineola NY 11501, USA. · Cardiac Catheterization Laboratory, Division of Cardiology, Winthrop University Hospital, 120 Mineola Boulevard, Suite 500, Mineola, NY 11501, USA. Electronic address: SSNaidu@Winthrop.org. ·Interv Cardiol Clin · Pubmed #28582203.

ABSTRACT: High-risk percutaneous coronary intervention (PCI) encompasses a growing portion of total PCIs performed and typically includes patients with high-risk clinical and anatomic characteristics. Such patients may represent not only a high-risk group for complications but also a group who may derive the most benefit from complete revascularization. Several hemodynamic support devices are available. Trial data, consensus documents, and guidelines currently recommend high-risk PCI aided by hemodynamic support devices, and this article discusses the patient populations who would benefit from such an approach, the available devices and strategies, and expected outcomes.

6 Clinical Trial Evaluating the learning curve in the prospective Randomized Clinical Trial of hemodynamic support with Impella 2.5 versus Intra-Aortic Balloon Pump in patients undergoing high-risk percutaneous coronary intervention: a prespecified subanalysis of the PROTECT II study. 2014

Henriques, José P S / Ouweneel, Dagmar M / Naidu, Srihari S / Palacios, Igor F / Popma, Jeffrey / Ohman, E Magnus / O'Neill, William W. ·Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.p.henriques@amc.uva.nl. · Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. · Winthrop University Hospital, Mineola, NY. · Massachusetts General Hospital, Boston, MA. · Beth Israel Deaconess Hospital, Boston, MA. · Duke University Medical Center, Durham, NC. · Henry Ford Hospital, Detroit, MI. ·Am Heart J · Pubmed #24655695.

ABSTRACT: BACKGROUND: The introduction of new medical devices may be accompanied by a learning curve. METHODS: To evaluate the impact of the device learning curve on the outcomes of PROTECT II trial, comparing Impella 2.5 versus the intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention, we report on a prespecified analysis, excluding the first Impella 2.5 and IABP patients at each site. RESULTS: A total of 448 patients were enrolled at 74 sites. Among these, 58 patients were the first to receive Impella 2.5 at their site, 62 were the first to receive IABP. A trend toward higher major adverse events (MAEs) at 30 days was observed for the subgroup of first versus remaining Impella 2.5 patients: 44.8% versus 31.7%, P = .072. MAE rates for the first and remaining IABP patients were similar at 30 days. After exclusion of the first patient in each group, MAE rates for Impella 2.5 and IABP were 31.7% versus 40.0% (P = .119) at 30 days and 38.0% versus 50.0% (P = .029) at 90 days. CONCLUSIONS: Significantly lower 90-day MAE rates were observed with the use of Impella 2.5 compared to the use of IABP after excluding the first patient per group at each site. This prespecified analysis suggests a learning curve associated with initial introduction of the Impella 2.5. Clinical trials should better address the training aspect of new devices, especially when compared with more established devices.

7 Clinical Trial Comparison of drug-eluting and bare metal stents for saphenous vein graft lesions (from the National Heart, Lung, and Blood Institute Dynamic Registry). 2010

Baldwin, Drew E / Abbott, J Dawn / Trost, Jeffrey C / Vlachos, Helen A / Selzer, Faith / Glaser, Ruchira / Wilensky, Robert L / Slater, James N / Doucet, Serge / Naidu, Srihari S / Aronow, Herbert D / Williams, David O. ·Tulane Heart and Vascular Institute, Tulane University, New Orleans, Louisiana, USA. ·Am J Cardiol · Pubmed #20854955.

ABSTRACT: The effectiveness and safety of drug-eluting stents (DES) compared with bare-metal stents (BMS) in saphenous vein graft (SVG) disease remains unclear. In particular, there is a paucity of data on long-term outcomes. In this study, 395 patients enrolled in the National Heart, Lung, and Blood Institute Dynamic Registry who underwent stenting of SVG lesions with BMS (n = 192) from 1999 to 2006 or DES (n = 203) from 2004 to 2006 were analyzed. Patients were followed prospectively for the occurrence of cardiovascular events and death at 3 years. Patients treated with DES were more likely to have diabetes mellitus and other co-morbidities and previous percutaneous coronary intervention. Treated lesions in DES patients were more complex than those in BMS patients. At 3 years of follow-up, the adjusted risk for target vessel revascularization (hazard ratio 1.03, 95% confidence interval 0.65 to 1.62, p = 0.91) and death or myocardial infarction (hazard ratio 0.72, 95% confidence interval 0.49 to 1.04, p = 0.08) was similar in patients treated with DES and those treated with BMS. The combined outcome of death, myocardial infarction, or target vessel revascularization excluding periprocedural myocardial infarction was also similar (adjusted hazard ratio 0.82, 95% confidence interval 0.62 to 1.09, p = 0.16). In conclusion, this multicenter nonrandomized study of unselected patients showed no benefit of DES in SVG lesions, including no reduction in target vessel revascularization, compared with BMS at 3 years. An adequately powered randomized controlled trial is needed to determine the optimal stent type for SVG percutaneous coronary intervention.

8 Article Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age. 2016

Epps, Kelly C / Holper, Elizabeth M / Selzer, Faith / Vlachos, Helen A / Gualano, Sarah K / Abbott, J Dawn / Jacobs, Alice K / Marroquin, Oscar C / Naidu, Srihari S / Groeneveld, Peter W / Wilensky, Robert L. ·From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.) · Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.) · Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.) · Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.) · Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.) · Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.) · Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.) · Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.) · and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.). ·Circ Cardiovasc Qual Outcomes · Pubmed #26908855.

ABSTRACT: BACKGROUND: Women <50 years of age with coronary artery disease may represent a group at higher risk for recurrent ischemic events after percutaneous coronary intervention (PCI); however, no long-term, multicenter outcomes assessment exists in this population. METHODS AND RESULTS: Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated the association of sex and age on cardiovascular-related outcomes in 10,963 patients (3797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI were primary outcomes comprising major adverse cardiovascular events. Although procedural success rates were similar by sex, the cumulative rate of major adverse cardiovascular events at 1 year was higher in young women (27.8 versus 19.9%; P=0.003), driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (coronary artery bypass graft surgery: 8.9% versus 3.9%, P<0.001, adjusted hazard ratio 2.4, 95% confidence interval 1.5-4.0; PCI: 19.0% versus 13.0%, P=0.005, adjusted hazard ratio 1.6, 95% confidence interval 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (coronary artery bypass graft surgery: 10.7% versus 6.8%, P=0.04, adjusted hazard ratio 1.71, 95% confidence interval 1.01-2.88; repeat PCI [target vessel]: 19.7% versus 11.8%, P=0.002, adjusted hazard ratio 1.8, 95% confidence interval 1.24-2.82). Compared with older women, younger women remained at increased risk of major adverse cardiovascular events, whereas all outcome rates were similar in older women and men. CONCLUSIONS: Young women, despite having less severe angiographic coronary artery disease, have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.

9 Article 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiología Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention. 2015

Rihal, Charanjit S / Naidu, Srihari S / Givertz, Michael M / Szeto, Wilson Y / Burke, James A / Kapur, Navin K / Kern, Morton / Garratt, Kirk N / Goldstein, James A / Dimas, Vivian / Tu, Thomas / Anonymous5050826. ·Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address: rihal@mayo.edu. · Division of Cardiology, Winthrop University Hospital, Mineola, New York. · Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. · Division of Cardiology, Lehigh Valley Heart Specialists, Allentown, Pennsylvania. · Cardiology, Tufts Medical Center, Boston, Massachusetts. · Division of Cardiology, UCI Medical Center, Orange, California. · Department of Cardiac and Vascular Services, Heart and Vascular Institute of New York, Lenox Hill Hospital, New York, New York. · Division of Cardiology, Beaumont Heart Center Clinic, Royal Oak, Michigan. · Pediatric Cardiology, UT Southwestern, Dallas, Texas. · Louisville Cardiology Group, Interventional Cardiology, Louisville, Kentucky. ·J Am Coll Cardiol · Pubmed #25861962.

ABSTRACT: -- No abstract --

10 Article Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study. 2014

Cohen, Mauricio G / Ghatak, Abhijit / Kleiman, Neal S / Naidu, Srihari S / Massaro, Joseph M / Kirtane, Ajay J / Moses, Jeffrey / Magnus Ohman, E / Džavík, Vladimír / Palacios, Igor F / Heldman, Alan W / Popma, Jeffrey J / O'Neill, William W. ·University of Miami Miller School of Medicine, Miami, Florida. ·Catheter Cardiovasc Interv · Pubmed #24174321.

ABSTRACT: OBJECTIVE: To study rotational atherectomy (RA) outcomes in patients undergoing high-risk PCI randomized to receive hemodynamic support using either IABP or Impella 2.5 in the PROTECT II trial. BACKGROUND: RA of heavily calcified lesions is often necessary for complex PCI but can be associated with slow-flow, hypotension, and higher risk of periprocedural MI. METHODS: We compared baseline, angiographic, procedural characteristics, and outcomes of patients treated with and without RA. We examined also RA technique and outcomes. RESULTS: RA was used in 52 of 448 patients (32 with Impella vs 20 with IABP, P = 0.08). RA patients were older (72 vs. 67 yo, P = 0.0009), more likely to have prior CABG (48 vs. 32%, P = 0.017), higher STS (8.1 vs. 5.7, P = 0.012) and higher SYNTAX scores (37 vs. 29, P < 0.0001). At 90 days, RA use was associated with higher incidence of MI but no mortality difference. RA was used more aggressively with Impella resulting in higher rate of periprocedural MI (P < 0.01), with no difference in mortality between groups (P = 0.78). Repeat revascularization occurred less frequently with Impella (P < 0.001). There were no differences in 90-day major adverse events between IABP and Impella in patients undergoing RA (P = 0.29). In patients not treated with RA, fewer MAEs were observed with Impella compared with IABP (P = 0.03). CONCLUSIONS: Patients who were treated with RA had more comorbidities, and more complex and extensive coronary artery disease. In patients with Impella, more aggressive RA use resulted in fewer revascularization events but higher incidence of periprocedural MI.

11 Article Contemporary incidence and predictors of stent thrombosis and other major adverse cardiac events in the year after XIENCE V implantation: results from the 8,061-patient XIENCE V United States study. 2012

Naidu, Srihari S / Krucoff, Mitchell W / Rutledge, David R / Mao, Vivian W / Zhao, Weiying / Zheng, Qing / Wilburn, Olivia / Sudhir, Krishnankutty / Simonton, Charles / Hermiller, James B. ·Division of Cardiology, Winthrop University Hospital, Mineola, New York 11501, USA. ssnaidu@winthrop.org ·JACC Cardiovasc Interv · Pubmed #22721657.

ABSTRACT: OBJECTIVES: The aim of this study was to identify predictors of clinical events after XIENCE V (Abbott Vascular, Santa Clara, California) stenting. BACKGROUND: The XIENCE V USA (XIENCE V Everolimus Eluting Coronary Stent System [EECSS] USA Post-Approval) study is a prospective, multicenter, Food and Drug Administration-required post-approval study to examine safety and effectiveness in real-world settings. After an initial 5,062 patients, 2,999 more were included as part of the DAPT (Dual Antiplatelet Therapy) trial (total n = 8,061). METHODS: One-year clinical events, including stent thrombosis (ST), cardiac death/myocardial infarction (MI), target lesion failure, and target lesion revascularization, were adjudicated according to Academic Research Consortium criteria, with ST and cardiac death/MI as primary and co-primary endpoints. Demographic, clinical, and procedural variables were assessed by multivariable analysis. A time-dependent covariate assessed the association between DAPT usage and ST. RESULTS: Roughly 61% were off-label; 85.6% remained on DAPT without interruption through 1 year. Incidences of definite/probable ST, cardiac death/MI, target lesion failure, and target lesion revascularization were 0.80% (95% confidence interval [CI]: 0.61% to 1.03%), 7.1% (95% CI: 6.51% to 7.68%), 8.9% (95% CI: 8.30% to 9.60%), and 4.3% (95% CI: 3.82% to 4.75%), respectively. Several independent clinical and angiographic predictors were identified for each outcome. Predictors of ST included DAPT interruption ≤ 30 days (hazard ratio [HR]: 8.63, 95% CI: 2.69 to 27.73, p = 0.0003), renal insufficiency (HR: 3.72, 95% CI: 1.71 to 8.09, p = 0.0009), and total stent length (HR: 1.30, 95% CI: 1.16 to 1.47, p < 0.0001). A DAPT interruption >30 days was not predictive of ST. CONCLUSIONS: In this large, real-world population, XIENCE V demonstrated low event rates at 1 year, with several independent predictors. Early DAPT interruption (≤ 30 days) was the most potent predictor of ST, whereas delayed interruption (>30 days) was not predictive. (XIENCE V Everolimus Eluting Coronary Stent System [EECSS] USA Post-Approval Study; NCT00676520).

12 Article Impact of severity of renal dysfunction on determinants of in-hospital mortality among patients undergoing percutaneous coronary intervention. 2012

Parikh, Puja B / Jeremias, Allen / Naidu, Srihari S / Brener, Sorin J / Lima, Fabio / Shlofmitz, Richard A / Pappas, Thomas / Marzo, Kevin P / Gruberg, Luis. ·Department of Medicine, Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York, USA. ·Catheter Cardiovasc Interv · Pubmed #22566286.

ABSTRACT: BACKGROUND: Chronic kidney disease (CKD) is a known prognostic indicator of poor outcomes following percutaneous coronary intervention (PCI) for coronary artery disease. However, it is unclear whether other predictors of mortality differ among patients with varying degrees of renal impairment. Thus, we aimed to identify determinants of in-hospital mortality which are specific to patients with preserved renal function, moderate CKD, or end stage renal disease (ESRD) on dialysis, undergoing PCI. METHODS: The study population included 25,018 patients who underwent PCI between January 1, 2004, and December 31, 2007, at four New York State hospitals. The primary endpoint of the study was in-hospital mortality. RESULTS: A total of 474 (1.9%) patients had ESRD on dialysis, 6,596 (26.4%) had moderate CKD (GFR<60 ml/min/1.73 m(2) ), and 17,948 (71.7%) had preserved renal function (GFR>60 ml/min/1.73 m(2) ). Patients with ESRD and moderate CKD were older, more often male, and had higher rates of prior coronary revascularization, peripheral vascular disease, congestive heart failure, prior stroke, and diabetes than those with preserved function. All-cause in-hospital mortality rates were significantly higher in patients with ESRD and moderate CKD compared to patients with GFR >60 ml/min/1.73 m(2) (2.1% and 1.3%, respectively vs. 0.3%, p < 0.001). In multivariable analysis, ESRD (OR: 3.68, 95% CI 1.62-8.36) and moderate CKD (OR: 2.92, 95% CI 1.91-4.46) were independently associated with higher rates of in-hospital mortality. Independent predictors of mortality were markedly distinct in each group and included female gender and myocardial infarction within the past 72 hr in the ESRD group, versus left ventricular ejection fraction, peripheral vascular disease, congestive heart failure, emergency PCI, and absence of prior PCI in the moderate CKD group and age, prior bypass graft surgery, congestive heart failure, emergency PCI, and absence of prior myocardial infarction in patients with preserved renal function. CONCLUSIONS: Patients with moderate CKD or ESRD undergoing PCI have an approximately threefold increase in the risk of in-hospital mortality compared with patients with preserved renal function, with radically different mortality predictors existing for varying levels of renal function.

13 Article Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: the USpella Registry. 2012

Maini, Brijeshwar / Naidu, Srihari S / Mulukutla, Suresh / Kleiman, Neal / Schreiber, Theodore / Wohns, David / Dixon, Simon / Rihal, Charanjit / Dave, Rajesh / O'Neill, William. ·Pinnacle Health System, Harrisburg, Pennsylvania, USA. bmaini@pinnaclehealth.org ·Catheter Cardiovasc Interv · Pubmed #22105829.

ABSTRACT: OBJECTIVES: We report on the real-world, multicenter experience of the Impella 2.5 circulatory support system during high-risk PCI, a subset of the larger USpella Registry. BACKGROUND: Standard of care for most patients with compromised ventricular function with multivessel or high-risk coronary lesions has been coronary artery bypass grafting. In poor operative candidates, high-risk PCI is increasingly considered, despite an increased risk for periprocedural hemodynamic compromise. METHODS: 175 consecutive patients who underwent high-risk PCI with prophylactic support of the Impella 2.5 were evaluated. The primary safety endpoint was the incidence of major adverse cardiac events (MACE) at 30 days. Secondary endpoints included safety and efficacy related to the device and patient outcomes, including survival at 12 months. RESULTS: Overall angiographic revascularization was successful in 99% of patients and in 90% of those with multivessel revascularization, resulting in a reduction of the mean SYNTAX score post-PCI from 36 ± 15 to 18 ± 15 (P < 0.0001) and an improvement of the ejection fraction (from 31 ± 15% to 36 ± 14%, P < 0.0001). In 51% of patients, the functional status improved by one or more NYHA class (P < 0.001). At 30-day follow-up, the rate of MACE was 8%, and survival was 96%, 91%, and 88% at 30 days, 6 months, and 12 months, respectively. CONCLUSIONS: The use of Impella 2.5 in high-risk PCI appeared feasible and safe in the real-world setting. The utilization of the Impella 2.5 was successful, resulting in favorable short- and midterm angiographic, procedural and clinical outcomes.

14 Article Association of health insurance status with presentation and outcomes of coronary artery disease among nonelderly adults undergoing percutaneous coronary intervention. 2011

Parikh, Puja B / Gruberg, Luis / Jeremias, Allen / Chen, John J / Naidu, Srihari S / Shlofmitz, Richard A / Brener, Sorin J / Pappas, Thomas / Marzo, Kevin P / Brown, David L. ·Department of Medicine, Division of Cardiovascular Medicine, State University of New York, Stony Brook University Medical Center, Stony Brook, NY, USA. ·Am Heart J · Pubmed #21884869.

ABSTRACT: OBJECTIVE: The aim of this study was to determine if insurance status is associated with adverse outcomes in patients with coronary artery disease. METHODS: A cohort of 13,456 patients who underwent percutaneous coronary intervention (PCI) between January 1, 2004, and December 31, 2007, at 4 New York State teaching hospitals was retrospectively studied. The primary outcome of interest was in-hospital mortality from any cause. RESULTS: Of the 13,456 patients studied, 11,927 (88.6%) were insured by private carriers, 1,036 (7.7%) patients were covered by Medicaid, and 493 (3.7%) were uninsured. Uninsured and Medicaid patients tended to be younger and more often nonwhite and Hispanic. They had a higher prevalence of congestive heart failure and worse left ventricular function. Compared with privately insured patients, uninsured and Medicaid patients had increased all-cause mortality (1.2% and 0.9%, respectively, vs 0.3%; P < .001). For all patients, lack of insurance (OR 3.02, 95% CI 1.10-8.28) and Medicaid (OR 4.39, 95% CI 1.93-9.99) were independently associated with mortality. Lack of insurance (OR 5.02, 95% CI 1.58-15.93) and Medicaid (OR 4.55, 95% CI 1.19-17.45) were also independently associated with increased mortality in patients undergoing emergent PCI. CONCLUSION: Lack of insurance and Medicaid insurance are both independently associated with an increased risk of in-hospital mortality after PCI for coronary artery disease.

15 Article Alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in patients with prior coronary revascularization. 2010

Khouzam, Rami N / Naidu, Srihari S. ·Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, New York, USA. ·J Invasive Cardiol · Pubmed #21127375.

ABSTRACT: Alcohol septal ablation has become an acceptable alternative to surgical myectomy in patients with hypertrophic obstructive cardiomyopathy who remain significantly symptomatic after optimized medical management and meet strict anatomic criteria. Given the prevalence of coronary artery disease and the variable phenotypic penetrance and age at first diagnosis of hypertrophic cardiomyopathy (HCM), patients may undergo coronary revascularization before a firm diagnosis of HCM is made. Patients with prior revascularization in the form of percutaneous coronary intervention or coronary artery bypass grafting pose unique challenges when contemplating and performing alcohol septal ablation. We present two cases of alcohol septal ablation after prior coronary revascularization, and discuss relevant concerns regarding patient selection, procedural technique and consequent durability of clinical outcome.

16 Article Three years since the FDA advisory panel on drug-eluting stents: what have we learned about off-label use and stent thrombosis? 2010

Naidu, Srihari S. ·Department of Medicine, Winthrop University Hospital, 120 Mineola Blvd, Suite 500, Mineola, NY, 11501, USA. ssnaidu@winthrop.org ·J Invasive Cardiol · Pubmed #20048394.

ABSTRACT: -- No abstract --

17 Minor Outpatient percutaneous coronary intervention: has its time come? 2014

Khouzam, Rami N / Soufi, Mohamad Khaled / Nakhla, Ramy / Naidu, Srihari S. ·University of Tennessee Health Science Center, Department of Medicine, Division of Cardiovascular Diseases, Memphis, Tennessee, USA. khouzamrami@yahoo.com. ·J Invasive Cardiol · Pubmed #25481000.

ABSTRACT: In the context of the rising health-care costs in the United States and the fact that approximately 1 million percutaneous coronary intervention (PCI) procedures are performed in the United States annually with a cost approaching $10 billion, reducing the cost associated with this frequently performed effective procedure has become paramount. Government and insurance-based methods have focused upon appropriate utilization and, in some cases, payment has been denied for procedures deemed inappropriate. While curtailing procedures may sometimes be reasonable, this approach is fraught with trouble, as individualized patient care does not fit neatly into population-based concepts of appropriateness. Therefore, alternative means to minimize expenditures should be entertained. Chief among these is the potential to reduce costs associated with PCI from prolonged inpatient stays for a procedure that, thankfully, has become significantly safer as it has maintained its efficacy. In this position paper, we discuss the theme of same-day discharge versus overnight stay after PCI as a cost-saving strategy, and pinpoint some criteria that can help to guide such a decision while preserving maximal patient safety and both patient and physician satisfaction.