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Coronary Artery Disease: HELP
Articles by James Nolan
Based on 12 articles published since 2010
(Why 12 articles?)
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Between 2010 and 2020, Jim Nolan wrote the following 12 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. 2013

Hamon, Martial / Pristipino, Christian / Di Mario, Carlo / Nolan, James / Ludwig, Josef / Tubaro, Marco / Sabate, Manel / Mauri-Ferré, Josepa / Huber, Kurt / Niemelä, Kari / Haude, Michael / Wijns, William / Dudek, Dariusz / Fajadet, Jean / Kiemeneij, Ferdinand / Anonymous3370748 / Anonymous3380748 / Anonymous3390748. ·Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France. hamon-m@chu-caen.fr ·EuroIntervention · Pubmed #23354100.

ABSTRACT: Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.

2 Review Readmissions to hospital after percutaneous coronary intervention: A systematic review and meta-analysis of factors associated with readmissions. 2019

Kwok, Chun Shing / Narain, Aditya / Pacha, Homam Moussa / Lo, Ted S / Holroyd, Eric W / Alraies, M Chadi / Nolan, Jim / Mamas, Mamas A. ·Keele Cardiovascular Research Group, Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK. Electronic address: shingkwok@doctors.org.uk. · Keele Cardiovascular Research Group, Primary Care & Health Sciences, Keele University, Stoke-on-Trent, UK; Royal Stoke University Hospital, Stoke-on-Trent, UK. · MedStar Washington Hospital Center, Washington, DC, USA. · Royal Stoke University Hospital, Stoke-on-Trent, UK. · Wayne State University, Detroit Medical Center, Detroit, MI, USA. ·Cardiovasc Revasc Med · Pubmed #31196797.

ABSTRACT: BACKGROUND: Readmissions after PCI are a burden to patients and health services that are not well understood. METHODS: A systematic review was performed to identify studies of readmission after PCI. Readmission rates and causes of readmission were examined and factors associated with 30-day readmissions were combined using meta-analyses. RESULTS: A total of 39 studies evaluated readmissions after PCI (6,569,690 patients, 31 studies). The 30-day readmission rate varied from 3.3%-15.8%. Beyond 30-days, the readmission rate was 6% at 2 months, 31.5% at 6 months, 18.6-50.4% at 12 months and 26.3-71% beyond 48 months. The pooled proportion of patients with cardiac cause for readmissions ranged from 4.6%-75.3%. The range of rates of 30-day readmissions for reinfarction/stent thrombosis, heart failure, chest pain and bleeding were 2.5%-9.5%, 5.9%-12%, 6.7-38.1% and 0.7-7.5%, respectively. Meta-analysis suggests that female gender (RR 1.25(1.20-1.30), I CONCLUSIONS: We estimate that 1 in 7 patients who undergo PCI are readmitted within 30-days and the rate can rise to up to 3 in 4 patients beyond 3 years. Interventions should be considered to reduce readmissions such as discharge checklists, evaluation of medication compliance at follow-up and prompt management when patients re-present to emergency department.

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

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

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

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

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

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

5 Article Outcomes Following Percutaneous Coronary Intervention in Non-ST-Segment-Elevation Myocardial Infarction Patients With Coronary Artery Bypass Grafts. 2018

Shoaib, Ahmad / Kinnaird, Tim / Curzen, Nick / Kontopantelis, Evangelos / Ludman, Peter / de Belder, Mark / Rashid, Muhammad / Kwok, Chun Shing / Nolan, James / Zaman, Azfar / Mamas, Mamas A. ·Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University (A.S., M.R., C.S.K., J.N., M.A.M.). · Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom (T.K.). · Faculty of Medicine, University of Southampton, United Kingdom (N.C.). · Institute for Primary Care Sciences, University of Manchester (E.K.). · Cardiology Department, Queen Elizabeth Hospital Birmingham, United Kingdom (P.L.). · Cardiology Department, James Cook University Hospital, Middlesbrough, United Kingdom (M.d.B.). · Academic Cardiology Department, Newcastle University, United Kingdom (A.Z.). ·Circ Cardiovasc Interv · Pubmed #30571201.

ABSTRACT: Background There are limited data on outcomes of patients with previous coronary artery bypass graft (CABG) presenting with non-ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). We compare clinical characteristics and outcomes in non-ST-segment-elevation myocardial infarction patients undergoing PCI with or without prior CABG surgery in a national cohort. Methods and Results We identified 205 039 patients with non-ST-segment-elevation myocardial infarction who underwent PCI between 2007 and 2014 in the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing into 3 groups: group 1, PCI in native coronary arteries and no prior CABG (n=186 670); group 2, PCI in native arteries with prior CABG (n=8825); group 3, PCI in grafts (n=9544). Patients in group 2 and 3 were older and had more comorbidities and higher mortality at 30 days (group 2, 2.6% and group 3, 1.9%) and 1 year (group 2, 8.29% and group 3, 7.08%) as compared with group 1 (1.7% and 4.87%). After multivariable analysis, no significant difference in outcomes was observed in 30-days mortality (odds ratio; group 2=0.87 [CI, 0.69-1.80; P=0.20], group 3=0.91 [CI, 0.71-1.17; P=0.46]), in-hospital major adverse cardiovascular event (odds ratio: group 2=1.08 [CI, 0.88-1.34; P=0.45], group 3=0.97 [CI=0.77-1.23; P=0.82]), and in-hospital stroke (odds ratio: group 2=1.37 [CI, 0.71-2.69; P=0.35], group 3=1.13 [CI, 0.55-2.34; P=0.73]; group 1=reference). Conclusions Patients with prior CABG are presenting with non-ST-segment-elevation myocardial infarction and treated with PCI had more comorbid illnesses, but once these differences were adjusted for, prior CABG did not independently confer additional risk of mortality and major adverse cardiovascular event.

6 Article Incidence, Determinants, and Outcomes of Left and Right Radial Access Use in Patients Undergoing Percutaneous Coronary Intervention in the United Kingdom: A National Perspective Using the BCIS Dataset. 2018

Rashid, Muhammad / Lawson, Claire / Potts, Jessica / Kontopantelis, Evangelos / Kwok, Chun Shing / Bertrand, Olivier Francois / Shoaib, Ahmad / Ludman, Peter / Kinnaird, Tim / de Belder, Mark / Nolan, James / Mamas, Mamas A. ·Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom. Electronic address: doctorrashid7@gmail.com. · Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom. · Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom. · Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom; Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, United Kingdom. · Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada. · Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom. · Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. · The James Cook University Hospital, Middlesbrough, United Kingdom. ·JACC Cardiovasc Interv · Pubmed #29778726.

ABSTRACT: OBJECTIVES: The authors sought to determine the relationships between left radial access (LRA) or right radial access (RRA) and clinical outcomes using the British Cardiovascular Intervention Society (BCIS) database. BACKGROUND: LRA has been shown to offer procedural advantages over RRA in percutaneous coronary intervention (PCI) although few data exist from a national perspective around its use and association with clinical outcomes. METHODS: The authors investigated the relationship between use of LRA or RRA and clinical outcomes of in-hospital or 30-day mortality, major adverse cardiovascular events (MACE), in-hospital stroke, and major bleeding complications in patients undergoing PCI between 2007 and 2014. RESULTS: Of 342,806 cases identified, 328,495 (96%) were RRA and 14,311 (4%) were LRA. Use of LRA increased from 3.2% to 4.6% from 2007 to 2014. In patients undergoing a repeat PCI procedure, the use of RRA dropped to 72% at the second procedure and was even lower in females (65%) and patients >75 years of age (70%). Use of LRA (compared with RRA) was not associated with significant differences in in-hospital mortality (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 0.90 to 1.57; p = 0.20), 30-day mortality (OR: 1.17, 95% CI: 0.93 to 1.74; p = 0.16), MACE (OR: 1.06, 95% CI: 0.86 to 1.32; p = 0.56), or major bleeding (OR: 1.22, 95% CI: 0.87 to 1.77; p = 0.24). In propensity match analysis, LRA was associated with a significant decrease in in-hospital stroke (OR: 0.52, 95% CI: 0.37 to 0.82; p = 0.005). CONCLUSIONS: In this large PCI database, use of LRA is limited compared with RRA but conveys no increased risk of adverse outcomes, but may be associated with a reduction in PCI-related stroke complications.

7 Article Vascular Access Site and Outcomes in 58,870 Patients Undergoing Percutaneous Coronary Intervention With a Previous History of Coronary Bypass Surgery: Results From the British Cardiovascular Interventions Society National Database. 2018

Kinnaird, Tim / Anderson, Richard / Gallagher, Sean / Cockburn, James / Sirker, Alex / Ludman, Peter / de Belder, Mark / Copt, Samuel / Nolan, James / Zaman, Azfar / Mamas, Mamas. ·Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk. · Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. · Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom. · Department of Cardiology, University College Hospital, London, United Kingdom. · Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom. · Department of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom. · Biosensors SA, Morges, Switzerland. · Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. · Department of Cardiology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom. ·JACC Cardiovasc Interv · Pubmed #29519382.

ABSTRACT: OBJECTIVES: Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, access site choice and outcomes of patients undergoing PCI with previous coronary artery bypass grafting (CABG) were studied. BACKGROUND: Given the influence of access site on outcomes, use of radial access in PCI-CABG warrants further investigation. METHODS: Data were analyzed from 58,870 PCI-CABG procedures performed between 2005 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes. RESULTS: The number of PCI-CABG cases and the percentage of total PCI increased significantly during the study period. Femoral artery (FA) utilization fell from 90.8% in 2005 to 57.6% in 2014 (p < 0.001), with no differences in the rate of change of left versus right radial use. In contemporary study years (2012 to 2014), female sex, acute coronary syndrome presentation, chronic total occlusion intervention, and lower operator volume were independently associated with FA access. Length of stay was shortened in the radial cohort. Unadjusted outcomes including an access site complication (1.10% vs. 0.30%; p < 0.001), blood transfusion (0.20% vs. 0.04%; p < 0.001), major bleeding (1.30% vs. 0.40%; p < 0.001), and in-hospital death (1.10% vs. 0.60%; p = 0.001) were more likely to occur with FA access compared with radial access. After adjustment, although arterial complications, transfusion, and major bleeding remained more common with FA use, short- and longer-term mortality and major adverse cardiac event rates were similar. CONCLUSIONS: In contemporary practice, FA access remains predominant during PCI-CABG with case complexity associated with it use. FA use was associated with longer length of stay, and higher rates of vascular complications, major bleeding, and transfusion.

8 Article Radial Versus Femoral Access for Rotational Atherectomy: A UK Observational Study of 8622 Patients. 2017

Watt, Jonathan / Austin, David / Mackay, Daniel / Nolan, James / Oldroyd, Keith G. ·From Raigmore Hospital, Inverness, United Kingdom (J.W.) · The James Cook University Hospital, Middlesbrough, United Kingdom (D.A.) · Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, United Kingdom (D.M.) · University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom (J.N.) · and Golden Jubilee National Hospital, Glasgow, United Kingdom (K.G.O.). ·Circ Cardiovasc Interv · Pubmed #29246910.

ABSTRACT: BACKGROUND: Rotational atherectomy (RA) is an important interventional tool for heavily calcified coronary lesions. We compared the early clinical outcomes in patients undergoing RA using radial or femoral access. METHODS AND RESULTS: We identified all patients in England and Wales who underwent RA between January 1, 2005, and March 31, 2014. Eight thousand six hundred twenty-two RA cases (3069 radial and 5553 femoral) were included in the analysis. The study primary outcome was 30-day mortality. Propensity scores were calculated to determine the factors associated with treatment assignment to radial or femoral access. Multivariable logistic regression analysis, using the calculated propensity scores, was performed. Thirty-day mortality was 2.2% in the radial and 2.3% in the femoral group ( CONCLUSIONS: In this large real-world study of patients undergoing RA, radial access was associated with equivalent 30-day mortality and procedural success, but reduced major bleeding and access site complications, compared with femoral access.

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

Hulme, William / Sperrin, Matthew / Kontopantelis, Evangelos / Ratib, Karim / Ludman, Peter / Sirker, Alex / Kinnaird, Tim / Curzen, Nick / Kwok, Chun Shing / De Belder, Mark / Nolan, James / Mamas, Mamas A / Anonymous5830896. ·From the Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, United Kingdom (W.H., M.S., E.K., M.A.M.) · Royal Stoke Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (K.R., C.S.K., J.N., M.A.M.) · Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.) · St. Bartholomew's Hospital, University College London Hospitals, United Kingdom (A.S.) · University Hospital of Wales, Cardiff, United Kingdom (T.K.) · Faculty of Medicine, University Hospital Southampton, University of Southampton, United Kingdom (N.C.) · Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.) · and The James Cook University Hospital, Middlesborough, United Kingdom (M.D.B.). ·Circ Cardiovasc Interv · Pubmed #28196898.

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

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

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

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

11 Article Does the Routine Availability of CT-Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?: The FFR 2016

Curzen, Nicholas P / Nolan, James / Zaman, Azfar G / Nørgaard, Bjarne L / Rajani, Ronak. ·University Hospital Southampton & Faculty of Medicine, University of Southampton, Southampton, United Kingdom. Electronic address: nick.curzen@uhs.nhs.uk. · University Hospitals of North Staffordshire, Stoke-on-Trent, United Kingdom. · Freeman Hospital, and Institute of Cellular Medicine Newcastle University, Newcastle upon Tyne, United Kingdom. · Aarhus University Hospital Skejby, Aarhus, Denmark. · Guy's & St. Thomas' Hospital, London, United Kingdom. ·JACC Cardiovasc Imaging · Pubmed #27568119.

ABSTRACT: OBJECTIVES: This study sought to determine the effect of adding computed tomography-derived fractional flow reserve (FFR BACKGROUND: Invasive and noninvasive tests used in the assessment of patients with angina all have disadvantages. The ideal screening test for patients presenting for the first time with chest pain would describe both coronary anatomy and the presence of ischemia and would be readily accessible, low cost, and noninvasive. METHODS: Two hundred patients with stable chest pain underwent CTA for clinical reasons, and FFR RESULTS: Overall, after disclosure of FFR CONCLUSIONS: This study demonstrates proof of concept that the availability of FFR

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

Kwok, Chun Shing / Anderson, Simon G / McAllister, Katherine S L / Sperrin, Matthew / O'Kane, Peter D / Keavney, Bernard / Nolan, James / Myint, Phyo Kyaw / Zaman, Azfar / Buchan, Iain / Ludman, Peter F / de Belder, Mark A / Mamas, Mamas A / Anonymous1520812. ·Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. ·Catheter Cardiovasc Interv · Pubmed #25408308.

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