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Coronary Artery Disease: HELP
Articles by Brahmajee K. Nallamothu
Based on 15 articles published since 2008
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Between 2008 and 2019, Brahmajee K. Nallamothu wrote the following 15 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 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 --

2 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 --

3 Article Comparative Outcomes After Percutaneous Coronary Intervention Among Black and White Patients Treated at US Veterans Affairs Hospitals. 2017

Kobayashi, Taisei / Glorioso, Thomas J / Armstrong, Ehrin J / Maddox, Thomas M / Plomondon, Mary E / Grunwald, Gary K / Bradley, Steven M / Tsai, Thomas T / Waldo, Stephen W / Rao, Sunil V / Banerjee, Subhash / Nallamothu, Brahmajee K / Bhatt, Deepak L / Rene, A Garvey / Wilensky, Robert L / Groeneveld, Peter W / Giri, Jay. ·Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania. · Penn Cardiovascular Outcomes, Quality, and Evaluation Research Center, Philadelphia, Pennsylvania. · Veterans Affairs Eastern Colorado Healthcare System, Denver. · University of Colorado School of Medicine, Aurora. · Colorado Cardiovascular Outcomes Research Consortium, Denver. · Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora. · Durham Veterans Affairs Medical Center, Durham, North Carolina. · Duke University, Durham, North Carolina. · Veterans Affairs North Texas Healthcare System, Dallas. · University of Texas Southwestern Medical Center, Dallas. · Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. · University of Michigan, Ann Arbor. · Veterans Affairs Boston Healthcare System, Boston, Massachusetts. · Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts. · Harvard Medical School, Boston, Massachusetts. ·JAMA Cardiol · Pubmed #28724126.

ABSTRACT: Importance: Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. Objective: To compare outcomes between black and white patients undergoing PCI in the VA health system. Design, Setting, and Participants: This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017. Exposure: Percutaneous coronary intervention at a VA hospital. Main Outcomes and Measures: The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access. Results: A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white patients. After adjustment for demographics, comorbidities, and procedural characteristics, odds for 1-year mortality (odds ratio, 1.04; 95% CI, 0.90-1.19) were not different between black and white patients. There were also no differences in secondary outcomes with the exception of a higher rate of adjusted 30-day acute kidney injury (odds ratio, 1.22; 95% CI, 1.10-1.36). Conclusions and Relevance: While black patients had a higher rate of mortality than white patients in unadjusted analyses, race was not independently associated with 1-year mortality among patients undergoing PCI in VA hospitals.

4 Article India and the Coronary Stent Market: Getting the Price Right. 2017

Wadhera, Priya / Alexander, Thomas / Nallamothu, Brahmajee K. ·From Michigan Integrated Center for Health Analytics and Medical Prediction, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (P.W., B.K.N.) · and Kovai Medical Center and Hospital, Coimbatore Tamil Nadu, India (T.A.). ·Circulation · Pubmed #28473448.

ABSTRACT: -- No abstract --

5 Article Longitudinal Risk of Adverse Events in Patients With Acute Kidney Injury After Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry. 2017

Valle, Javier A / McCoy, Lisa A / Maddox, Thomas M / Rumsfeld, John S / Ho, P Michael / Casserly, Ivan P / Nallamothu, Brahmajee K / Roe, Matthew T / Tsai, Thomas T / Messenger, John C. ·From the Division of Cardiology, University of Colorado School of Medicine, Aurora (J.A.V., T.M.M., J.S.R., P.M.H., T.T.T., J.C.M.) · Duke Clinical Research Institute, Durham, NC (L.A.M., M.T.R.) · Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (T.M.M., P.M.H.) · Division of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland (I.P.C.) · Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (B.K.N.) · Division of Cardiology, Duke University, Durham, NC (M.T.R.) · and Department of Cardiology, Institute for Health Research, Kaiser Permanente Colorado, Denver (T.T.T.). ·Circ Cardiovasc Interv · Pubmed #28404621.

ABSTRACT: BACKGROUND: Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post-PCI AKI is poorly defined, and the relationship between AKI and outcomes after hospital discharge remains understudied. METHODS AND RESULTS: Using the National Cardiovascular Data Registry CathPCI registry, we assessed the incidence of AKI among Medicare beneficiaries after PCI from 2004 to 2009 and subsequent post-discharge adverse events at 1 year. AKI was defined using Acute Kidney Injury Network (AKIN) criteria. Adverse events included death, myocardial infarction, bleeding, and recurrent kidney injury. Using Cox methods, we determined the relationship between in-hospital AKI and risk of post-discharge adverse events by AKIN stage. In a cohort of 453 475 elderly patients undergoing PCI, 39 850 developed AKI (8.8% overall; AKIN stage 1, 85.8%; AKIN 2/3, 14.2%). Compared with no AKI, in-hospital AKI was associated with higher post-discharge hazard of death, myocardial infarction, or bleeding (AKIN 1: hazard ratio [HR], 1.53; confidence interval [CI], 1.49-1.56 and AKIN 2/3: HR, 2.13; CI, 2.01-2.26), recurrent AKI (AKIN 1: HR, 1.70; CI, 1.64-1.76; AKIN 2/3: HR, 2.22; CI, 2.04-2.41), and AKI requiring dialysis (AKIN 1: HR, 2.59; CI, 2.29-2.92; AKIN 2/3: HR, 4.73; CI, 3.73-5.99). For each outcome, the highest incidence was within 30 days. CONCLUSIONS: Post-PCI AKI is associated with increased risk of death, myocardial infarction, bleeding, and recurrent renal injury after discharge. Post-PCI AKI should be recognized as a significant risk factor not only for in-hospital adverse events but also after hospital discharge.

6 Article Patterns of Institutional Review of Percutaneous Coronary Intervention Appropriateness and the Effect on Quality of Care and Clinical Outcomes. 2015

Desai, Nihar R / Parzynski, Craig S / Krumholz, Harlan M / Minges, Karl E / Messenger, John C / Nallamothu, Brahmajee K / Curtis, Jeptha P. ·Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut. · Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, New Haven, Connecticut. · Division of Cardiology, University of Colorado School of Medicine, Aurora. · Division of Cardiovascular Diseases, University of Michigan, Ann Arbor5Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan. ·JAMA Intern Med · Pubmed #26551259.

ABSTRACT: -- No abstract --

7 Article Validation of the appropriate use criteria for percutaneous coronary intervention in patients with stable coronary artery disease (from the COURAGE trial). 2015

Bradley, Steven M / Chan, Paul S / Hartigan, Pamela M / Nallamothu, Brahmajee K / Weintraub, William S / Sedlis, Steven P / Dada, Marcin / Maron, David J / Kostuk, William J / Berman, Daniel S / Teo, Koon K / Mancini, G B John / Boden, William E / Spertus, John A. ·Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado. Electronic address: smbradle@gmail.com. · Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Missouri; Department of Medicine, University of Missouri-Kansas City, Missouri. · Department of Medicine, Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, Connecticut. · Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan. · Department of Medicine, Christiana Care Health System, Newark, Delaware. · Division of Cardiology, Department of Medicine, VA New York Harbor Health Care System, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York. · Department of Medicine, Hartford Hospital, Hartford, Connecticut. · Department of Medicine, Stanford University School of Medicine, Stanford, California. · Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. · Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, Western New York VA Healthcare Network, Buffalo, New York; Buffalo General Hospital, SUNY, Buffalo, New York. ·Am J Cardiol · Pubmed #25960375.

ABSTRACT: Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial patients with stable ischemic heart disease randomized to PCI with optimal medical therapy (OMT) or OMT alone. Within appropriateness categories, we compared rates of death, myocardial infarction, revascularization subsequent to initial therapy, and angina-specific health status as determined by the Seattle Angina Questionnaire in patients randomized to PCI + OMT to those randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to the 2012 publication of the AUC, with 1,334 (67.1%) classified as appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There were no significant differences between PCI and OMT alone in the rate of mortality and myocardial infarction by appropriateness classification. Rates of revascularization were significantly lower in patients initially receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65; 95% confidence interval 0.53 to 0.80; p <0.001) or uncertain (hazard ratio 0.49; 95% confidence interval 0.32 to 0.76; p = 0.001). Furthermore, among patients classified as appropriate by the AUC, Seattle Angina Questionnaire scores at 1 month were better in the PCI-treated group compared with the medical therapy group (80 ± 23 vs 75 ± 24 for angina frequency, 73 ± 24 vs 68 ± 24 for physical limitations, and 68 ± 23 vs 60 ± 24 for quality of life; all p <0.01), with differences generally persisting through 12 months. In contrast, health status scores were similar throughout the first year of follow-up in PCI + OMT patients compared with OMT alone in patients classified as uncertain or inappropriate. In conclusion, these findings support the validity of the AUC in efforts to improve health care quality through optimal use of PCI.

8 Article Antithrombotic therapy and outcomes after ICD implantation in patients with atrial fibrillation and coronary artery disease: an analysis from the National Cardiovascular Data Registry (NCDR)®. 2015

Ghanbari, Hamid / Nallamothu, Brahmajee K / Wang, Yongfei / Curtis, Jeptha P. ·Section of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI (H.G., B.K.N.). · Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (Y.W., J.P.C.). ·J Am Heart Assoc · Pubmed #25637345.

ABSTRACT: BACKGROUND: Management of antithrombotic agents after implantable cardioverter defibrillator implantation is challenging, particularly among patients with atrial fibrillation and coronary artery disease. METHODS AND RESULTS: Using data from National Cardiovascular Data Registry(®) Implantable Cardioverter Defibrillator Registry(™) linked with Medicare claims data, we identified 25 180 patients with atrial fibrillation and coronary artery disease who underwent implantable cardioverter defibrillator implantation. Patients were categorized into 5 different groups according to antithrombotic agents prescribed at discharge (any 1 antiplatelet agent [A, n=6538], dual antiplatelet therapy [DA, n=3414], warfarin [n=5264], warfarin+A [n=7994], warfarin+DA [n=1970]). We assessed the primary outcomes occurring within 30 days of hospital discharge. Combinations of DA (adjusted hazard ratio [HR]: 1.39; 95% CI: 1.03 to 1.87), warfarin+A (adjusted HR: 1.32; 95% CI: 1.03 to 1.69), and warfarin+DA (adjusted HR: 2.03; 95% CI: 1.49 to 2.77) were associated with a higher bleeding risk. The risk of major adverse cardiovascular events was higher in patients discharged with A (adjusted HR: 1.69; 95% CI: 1.33 to 2.16), DA (adjusted HR: 2.17; 95% CI: 1.66 to 2.83), and DA+warfarin (adjusted HR: 1.61; 1.16 to 2.24). There was no association between postdischarge antithrombotic agents and thromboembolic events or device-related complications. CONCLUSIONS: Short-term bleeding risk and major adverse cardiovascular events differ with usage patterns of antithrombotic agents, while the risk of thromboembolic events and device-related complications is relatively constant. These data may help clinicians balance risks and benefits when choosing antithrombotic therapy following implantable cardioverter defibrillator implantation.

9 Article Symptoms and angiographic findings of patients undergoing elective coronary angiography without prior stress testing. 2014

Abdallah, Mouin S / Spertus, John A / Nallamothu, Brahmajee K / Kennedy, Kevin F / Arnold, Suzanne V / Chan, Paul S. ·University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri. Electronic address: mouinabdallah2010@gmail.com. · University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri. · Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan. · Saint Luke's Mid America Heart Institute, Kansas City, Missouri. ·Am J Cardiol · Pubmed #24890987.

ABSTRACT: Many patients undergo elective coronary angiography without preprocedural stress testing that may be suitable if performed in patients with more angina pectoris or more frequently identified obstructive coronary artery disease (CAD). Patients in the National Cardiovascular Data Registry CathPCI Registry undergoing elective coronary angiography from July 2009 to April 2013 were assessed for differences in angina (Canadian Cardiovascular Society [CCS] class) and severity of obstructive CAD in those with and without preprocedural stress testing, stratified by CAD history. Given the large sample size, differences were considered clinically meaningful if the standardized difference (SD) was >10%. Of 790,601 patients without CAD history, 36.9% did not undergo preprocedural stress testing. Compared with patients with preprocedural stress testing, patients without preprocedural stress testing were more frequently angina free (CCS class 0; 28.2% with stress test vs 38.5% without, SD = 14.8%) and had similar rates of obstructive CAD (40.1% with stress test vs 35.7% without, SD = 9.0). Of 449,579 patients with CAD history, 44.2% did not undergo preprocedural stress testing. Patients without preprocedural stress testing reported more angina (CCS class III/IV angina: 17.8% vs 13.4%; SD = 11.3%) but were not more likely to have obstructive CAD (78.7% vs 81.1%; SD = 5.8%) than patients with preprocedural stress testing. In conclusion, approximately 40% of patients undergoing elective coronary angiography did not have preprocedural risk stratification with stress testing. For these patients, the clinical decision to proceed directly to invasive evaluation was not driven primarily by severe angina and did not result in higher detection rates for obstructive CAD.

10 Article Multivessel versus culprit vessel percutaneous coronary intervention in ST-elevation myocardial infarction: is more worse? 2013

Jaguszewski, Milosz / Radovanovic, Dragana / Nallamothu, Brahmajee K / Lüscher, Thomas F / Urban, Philip / Eberli, Franz R / Bertel, Osmund / Pedrazzini, Giovanni B / Windecker, Stephan / Jeger, Raban / Erne, Paul / Anonymous2470780. ·Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. ·EuroIntervention · Pubmed #24384288.

ABSTRACT: AIMS: We examined what type of STEMI patients are more likely to undergo multivessel PCI (MPCI) in a "real-world" setting and whether MPCI leads to worse or better outcomes compared with single-vessel PCI (SPCI) after stratifying patients by risk. METHODS AND RESULTS: Among STEMI patients enrolled in the Swiss AMIS Plus registry between 2005 and 2012 (n=12,000), 4,941 were identified with multivessel disease. We then stratified patients based on MPCI use and their risk. High-risk patients were identified a priori as those with: 1) left main (LM) involvement (lesions, n=263); 2) out-of-hospital cardiac arrest; or 3) Killip class III/IV. Logistic regression models examined for predictors of MPCI use and the association between MPCI and in-hospital mortality. Three thousand eight hundred and thirty-three (77.6%) patients underwent SPCI and 1,108 (22.4%) underwent MPCI. Rates of MPCI were greater among high-risk patients for each of the three categories: 8.6% vs. 5.9% for out-of-hospital cardiac arrest (p<0.01); 12.3% vs. 6.2% for Killip III/IV (p<0.001); and 14.5% vs. 2.7% for LM involvement (p<0.001). Overall, in-hospital mortality after MPCI was higher when compared with SPCI (7.3% vs. 4.4%; p<0.001). However, this result was not present when patients were stratified by risk: in-hospital mortality for MPCI vs. SPCI was 2.0% vs. 2.0% (p=1.00) in low-risk patients and 22.2% vs. 21.7% (p=1.00) in high-risk patients. CONCLUSIONS: High-risk patients are more likely to undergo MPCI. Furthermore, MPCI does not appear to be associated with higher mortality after stratifying patients based on their risk.

11 Article Contemporary use and effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy among patients undergoing percutaneous coronary intervention. 2012

Gurm, Hitinder S / Smith, Dean E / Berwanger, Otavio / Share, David / Schreiber, Theodore / Moscucci, Mauro / Nallamothu, Brahmajee K / Anonymous290715. ·Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5853, USA. hgurm@med.umich.edu ·JACC Cardiovasc Interv · Pubmed #22230155.

ABSTRACT: OBJECTIVES: The aim of this study was to examine the use of and outcomes associated with use of N-acetylcysteine (NAC) in real-world practice. BACKGROUND: The role of NAC in the prevention of contrast-induced nephropathy (CIN) is controversial, leading to widely varying recommendations for its use. METHODS: Use of NAC was assessed in consecutive patients undergoing nonemergent percutaneous coronary intervention from 2006 to 2009 in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, a large multicenter quality improvement collaborative. We examined the overall prevalence of NAC use in these patients and then used propensity matching to link its use with clinical outcomes, including CIN, nephropathy-requiring dialysis, and death. RESULTS: Of the 90,578 percutaneous coronary interventions performed during the study period, NAC was used in 10,574 (11.6%) procedures, with its use steadily increasing over the study period. Patients treated with NAC were slightly older and more likely to have baseline renal insufficiency and other comorbidities. In propensity-matched, risk-adjusted models, we found no differences in outcomes between patients treated with NAC and those not receiving NAC for CIN (5.5% vs. 5.5%, p = 0.99), nephropathy-requiring dialysis (0.6% vs. 0.6%, p = 0.69), or death (0.6% vs. 0.8%, p = 0.15). These findings were consistent across many prespecified subgroups. CONCLUSIONS: Use of NAC is common and has steadily increased over the study period but does not seem to be associated with improved clinical outcomes in real-world practice.

12 Article Systems of care for ST-elevation myocardial infarction in India. 2012

Alexander, Thomas / Mehta, Sameer / Mullasari, Ajit / Nallamothu, Brahmajee K. ·Kovai Medical Centre and Hospital, P.B. 3209, Avanashi Road,Coimbatore, 641014, India. tomalex41@gmail.com ·Heart · Pubmed #22076013.

ABSTRACT: The prevalence of coronary artery disease and ST-elevation myocardial infarction (STEMI) are increasing in India. Although recent publications have focused on improving preventive measures in developing countries, less attention has been placed on the acute management of STEMI. Recent policy changes in India have provided new opportunities to address existing barriers but require greater investment and support in the coming years.

13 Article Putting ad hoc PCI on pause. 2010

Nallamothu, Brahmajee K / Krumholz, Harlan M. ·The Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence, Division of Cardiovascular Medicine and Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, Michigan, USA. bnallamo@umich.edu ·JAMA · Pubmed #21063016.

ABSTRACT: -- No abstract --

14 Article Coronary revascularization at specialty cardiac hospitals and peer general hospitals in black Medicare beneficiaries. 2008

Nallamothu, Brahmajee K / Lu, Xin / Vaughan-Sarrazin, Mary S / Cram, Peter. ·Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, Mich, USA. bnallamo@umich.edu ·Circ Cardiovasc Qual Outcomes · Pubmed #20031798.

ABSTRACT: BACKGROUND: Critics have raised concerns that specialty cardiac hospitals exacerbate racial disparities in cardiovascular care, but empirical data are limited. METHODS AND RESULTS: We used administrative data from the Medicare Provider and Analysis Review Part A and Provider-of-Service files from 2002 to 2005. Multivariable logistic regression models were constructed to examine the likelihood of black Medicare patients being admitted to a cardiac hospital for coronary revascularization when compared with white patients within the same healthcare referral region after accounting for geographic proximity to the nearest hospitals, procedural acuity, and comorbidities. We identified 35 309 patients who underwent coronary artery bypass grafting in 18 healthcare referral regions and 94,525 patients who underwent percutaneous coronary intervention in 20 healthcare referral regions where cardiac hospitals performed these procedures. Patients at cardiac hospitals were more likely to be men and white and have less comorbidity than those at general hospitals. The likelihood of black patients undergoing coronary revascularization at a cardiac hospital was significantly lower for coronary artery bypass grafting (adjusted odds ratio, 0.67; P=0.01) and percutaneous coronary intervention (adjusted odds ratio, 0.63; P<0.0001). However, this relationship was substantially attenuated among black patients living in close proximity (ie, within 10 miles) to cardiac hospitals (adjusted odds ratio for coronary artery bypass grafting, 0.95; P=0.75; adjusted odds ratio for percutaneous coronary intervention, 0.78; P=0.01). CONCLUSIONS: Black patients were significantly less likely to be admitted at cardiac hospitals for coronary revascularization. Precise reasons for these findings are unclear but suggest complex associations between race and geography in decisions about where to receive care.

15 Minor Use of Fractional Flow Reserve in Elderly Patients Undergoing Elective Percutaneous Coronary Intervention: Does Prior Stress Testing Matter? 2017

Joseph, Timothy A / Lehrich, Jessica / Chan, Paul S / Curtis, Jeptha P / Desai, Nihar R / Murthy, Venkatesh L / Curzen, Nick / Nallamothu, Brahmajee K. · ·JACC Cardiovasc Interv · Pubmed #28231913.

ABSTRACT: -- No abstract --