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Coronary Artery Disease: HELP
Articles by Robert N. Piana
Based on 8 articles published since 2008

Between 2008 and 2019, Robert Piana wrote the following 8 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Guideline The Rationale for Performance of Coronary Angiography and Stenting Before Transcatheter Aortic Valve Replacement: From the Interventional Section Leadership Council of the American College of Cardiology. 2016

Ramee, Stephen / Anwaruddin, Saif / Kumar, Gautam / Piana, Robert N / Babaliaros, Vasilis / Rab, Tanveer / Klein, Lloyd W / Anonymous11460889 / Anonymous11470889. ·Ochsner Medical Center, New Orleans, Louisiana. · Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. · Emory University/Atlanta VA Medical Center, Atlanta, Georgia. · Vanderbilt University Medical Center, Nashville, Tennessee. · Emory University School of Medicine, Atlanta, Georgia. · Rush Medical College, Chicago, Illinois. Electronic address: lloydklein@comcast.net. ·JACC Cardiovasc Interv · Pubmed #27931592.

ABSTRACT: Transcatheter aortic valve replacement (TAVR) is an effective, nonsurgical treatment option for patients with severe aortic stenosis. The optimal treatment strategy for treating concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. Nevertheless, it is standard practice in the United States to perform coronary angiography and percutaneous coronary intervention for significant CAD at least 1 month before TAVR. All existing clinical trials were designed using this strategy. Therefore, it is wrong to extrapolate current American College of Cardiology/American Heart Association Appropriate Use Criteria against invasive procedures in asymptomatic patients to the TAVR population when evaluating the quality of care by cardiologists or hospitals. In this statement from the Interventional Section Leadership Council of the ACC, it is recommended that percutaneous coronary intervention should be considered in all patients with significant proximal coronary stenosis in major coronary arteries before TAVR, even though the indication is not covered in current guidelines.

2 Clinical Trial SPIRIT IV trial design: a large-scale randomized comparison of everolimus-eluting stents and paclitaxel-eluting stents in patients with coronary artery disease. 2009

Nikolsky, Eugenia / Lansky, Alexandra J / Sudhir, Krishnankutty / Doostzadeh, Julie / Cutlip, Donald E / Piana, Robert / Su, Xiaolu / White, Roseann / Simonton, Charles A / Stone, Gregg W. ·Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY 10022, USA. ·Am Heart J · Pubmed #19781409.

ABSTRACT: BACKGROUND: In the 300-patient SPIRIT II and 1002-patient SPIRIT III randomized trials, the everolimus-eluting stent (EES) compared to the paclitaxel-eluting stent (PES) resulted in reduced angiographic late loss (a primary end point in both trials), noninferior rates of 9-month target vessel failure (a primary end point in SPIRIT III), and reduced rates of target lesion revascularization and major adverse cardiac events (secondary end points). However, neither trial was powered for superiority for clinical end points, and the routine performance of angiographic follow-up may have artificially exaggerated the absolute benefits of EES. The relative efficacy of these 2 stents in patients with diabetes mellitus also remains controversial. We therefore designed a large-scale randomized trial without angiographic follow-up to further assess the differences between these 2 stent platforms. STUDY DESIGN: SPIRIT IV is an ongoing prospective, active-controlled, single-blinded, multicenter clinical trial in which 3690 patients with native coronary artery disease have been randomized 2:1 to EES versus PES. Patients with up to 3 de novo native coronary artery lesions (maximum 2 lesions per epicardial vessel) with length or=2.5 to The magnitude of the study will also permit significant insights to be gained into the relative performance of the 2 stents in important subgroups, including patients with diabetes mellitus.

3 Article The learning curve for transradial percutaneous coronary intervention among operators in the United States: a study from the National Cardiovascular Data Registry. 2014

Hess, Connie N / Peterson, Eric D / Neely, Megan L / Dai, David / Hillegass, William B / Krucoff, Mitchell W / Kutcher, Michael A / Messenger, John C / Pancholy, Samir / Piana, Robert N / Rao, Sunil V. ·From the Duke Clinical Research Institute, Durham, NC (C.N.H., E.D.P., M.L.N., D.D., M.W.K., S.V.R.) · University of Alabama at Birmingham, Birmingham, AL (W.B.H.) · Wake Forest University School of Medicine, Winston-Salem, NC (M.A.K.) · University of Colorado, Denver, CO (J.C.M.) · The Wright Center for Graduate Medical Education, Scranton, PA (S.P.) · Vanderbilt Heart Center, Nashville, TN (R.N.P.). ·Circulation · Pubmed #24756064.

ABSTRACT: BACKGROUND: Adoption of transradial percutaneous coronary intervention (TRI) in the United States is low and may be related to challenges learning the technique. We examined the relationships between operator TRI volume and procedural metrics and outcomes. METHODS AND RESULTS: We used CathPCI Registry data from July 2009 to December 2012 to identify new radial operators, defined by an exclusively femoral percutaneous coronary intervention approach for 6 months after their first percutaneous coronary intervention in the database and ≥15 total TRIs thereafter. Primary outcomes of fluoroscopy time, contrast volume, and procedure success were chosen as markers of technical proficiency. Secondary outcomes included in-hospital mortality, bleeding, and vascular complications. Adjusted outcomes were analyzed by using operator TRI experience as a continuous variable with generalized linear mixed models. Among 54 561 TRI procedures performed at 704 sites, 942 operators performed 1 to 10 procedures, 942 operators performed 11 to 50 procedures, 375 operators performed 51 to 100 procedures, and 148 operators performed 101 to 200 procedures. As radial caseload increased, more TRIs were performed in women, in patients presenting with ST-segment elevation myocardial infarction, and for emergency indications. Decreased fluoroscopy time and contrast use were nonlinearly associated with greater operator TRI experience, with faster reductions observed for newer (<30-50 cases) compared with more experienced (>30-50 cases) operators. Procedure success was high, whereas mortality, bleeding, and vascular complications remained low across TRI volumes. CONCLUSIONS: As operator TRI volume increases, higher-risk patients are chosen for TRI. Despite this, operator proficiency improves with greater TRI experience, and safety is maintained. The threshold to overcome the learning curve appears to be approximately 30 to 50 cases.

4 Article Predicting target vessel revascularization in older patients undergoing percutaneous coronary intervention in the drug-eluting stent era. 2014

Hess, Connie N / Rao, Sunil V / Dai, David / Neely, Megan L / Piana, Robert N / Messenger, John C / Peterson, Eric D. ·Duke Clinical Research Institute, Durham, NC. · Vanderbilt Heart Center, Nashville, TN. · University of Colorado School of Medicine, Denver, CO. · Duke Clinical Research Institute, Durham, NC. Electronic address: eric.peterson@duke.edu. ·Am Heart J · Pubmed #24655708.

ABSTRACT: BACKGROUND: The contemporary need for repeat revascularization in older patients after percutaneous coronary intervention (PCI) has not been well studied. Understanding repeat revascularization risk in this population may inform treatment decisions. METHODS: We analyzed patients ≥65 years old undergoing native-vessel PCI of de novo lesions from 2005 to 2009 discharged alive using linked CathPCI Registry and Medicare data. Repeat PCIs within 1 year of index procedure were identified by claims data and linked back to CathPCI Registry to identify target vessel revascularization (TVR). Surgical revascularization and PCIs not back linked to CathPCI Registry were excluded from main analyses but included in sensitivity analyses. Independent predictors of TVR after drug-eluting stent (DES) or bare-metal stent (BMS) implantation were identified by multivariable logistic regression. RESULTS: Among 343,173 PCI procedures, DES was used in 76.5% (n = 262,496). One-year TVR ranged from 3.3% (overall) to 7.1% (sensitivity analysis). Precatheterization and additional procedure-related TVR risk models were developed in BMS (c-indices 0.54, 0.60) and DES (c-indices 0.57, 0.60) populations. Models were well calibrated and performed similarly in important patient subgroups (female, diabetic, and older [≥75 years]). The use of DES reduced predicted TVR rates in high-risk older patients by 35.5% relative to BMS (from 6.2% to 4.0%). Among low-risk patients, the number needed to treat with DES to prevent 1 TVR was 63-112; among high-risk patients, this dropped to 28-46. CONCLUSIONS: In contemporary clinical practice, native-vessel TVR among older patients occurs infrequently. Our prediction model identifies patients at low versus high TVR risk and may inform clinical decision making.

5 Article In-hospital and one year outcomes with drug-eluting versus bare metal stents in large native coronary arteries: a report from the Evaluation of Drug-Eluting Stents and Ischemic Events registry. 2013

Gordon, Paul C / Cohen, David J / Kleiman, Neal S / Montgomery, Jay A / Semder, Christopher A / Kennedy, Kevin F / Keyes, Michelle J / Piana, Robert N / Anonymous4470723. ·Division of Cardiology, The Miriam Hospital, Providence, Rhode Island. ·Catheter Cardiovasc Interv · Pubmed #22511502.

ABSTRACT: OBJECTIVES: We sought to compare the clinical outcomes after percutaneous coronary revascularization of large coronary arteries using drug-eluting (DES) or bare-metal (BMS) stents. BACKGROUND: In de novo native coronary lesions with reference diameters of 2.5-3.5 mm, DES reduce target lesion revascularization (TLR) with no increase in death or myocardial infarction (MI). The relative efficacy of DES in larger coronary artery lesions is less certain. METHODS: From the prospective Evaluation of Drug-Eluting Stents and Ischemic Events registry, we identified patients undergoing stenting of de novo lesions in native coronary arteries 3.5-5.0 mm in diameter (n = 1,485). In-hospital and 1-year clinical outcomes were compared for BMS (n = 282) and DES (n = 1,203) patients, using propensity stratification to adjust for differences in potential confounding factors. RESULTS: Most patient characteristics were similar for the two groups, but BMS patients were more likely to have been treated in the setting of ST elevation MI, whereas DES patients had more bifurcation lesions, smaller vessels, and longer total stent lengths. In risk-adjusted analyses, the composite endpoint of 1-year death, MI or TLR was similar for BMS and DES (standardized rate: 11.9% vs. 8.5%, P = 0.10). DES was associated with a 62% reduction in the risk of TLR, although the absolute difference in event rates was small (standardized rates 4.6% vs. 1.8%, P = 0.016). CONCLUSIONS: Among relatively unselected patients undergoing PCI of large native coronary arteries, use of DES was associated with a modest reduction in rates of TLR, with a neutral effect on other ischemic endpoints.

6 Article Prognostic impact of periprocedural bleeding and myocardial infarction after percutaneous coronary intervention in unselected patients: results from the EVENT (evaluation of drug-eluting stents and ischemic events) registry. 2009

Lindsey, Jason B / Marso, Steven P / Pencina, Michael / Stolker, Joshua M / Kennedy, Kevin F / Rihal, Charanjit / Barsness, Greg / Piana, Robert N / Goldberg, Steven L / Cutlip, Donald E / Kleiman, Neal S / Cohen, David J / Anonymous4210643. ·Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri 64111, USA. ·JACC Cardiovasc Interv · Pubmed #19926047.

ABSTRACT: OBJECTIVES: Our aim was to examine the prognostic importance of hemorrhagic and ischemic complications after percutaneous coronary intervention (PCI) in unselected patients. BACKGROUND: In randomized trials of PCI, major bleeding and periprocedural myocardial infarction (pMI) have been associated with increased mortality. Whether similar associations exist among un-selected PCI patients is unknown. METHODS: We used data from the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry-a multicenter registry of unselected patients undergoing PCI-to examine the association between both in-hospital bleeding and pMI and 1-year mortality. Cardiac enzyme levels were assessed in all patients, and pMI was defined as a peak creatine kinase-MB value >or=3x the upper limit of normal. Post-PCI bleeding was classified by Thrombolysis In Myocardial Infarction criteria. RESULTS: After excluding patients with elevated pre-PCI creatine kinase-MB values and ST-segment elevation myocardial infarction at presentation (n = 1,626), a total of 5,961 patients were available for evaluation. Rates of post-PCI bleeding and pMI were 3.0% and 7.1%, respectively; 1-year all-cause mortality was 2.8%. After multivariable adjustment, both post-PCI bleeding (adjusted hazard ratio [HR]: 3.83, 95% confidence interval: 2.48 to 5.90, p < 0.001) and pMI (adjusted HR: 1.84, 95% confidence interval: 1.17 to 2.89, p = 0.009) were independently associated with 1-year mortality. Time period-specific analyses demonstrated that the adjusted HR for bleeding was similar for 30-day mortality and mortality between 1 month and 1 year, while the adjusted HR for pMI was greater for 30-day mortality as compared with mortality between 1 month and 1 year. CONCLUSIONS: Among unselected PCI patients, both post-PCI bleeding and pMI are independently associated with increased 1-year mortality. Continued efforts to reduce these complications after PCI are warranted.

7 Article Cataloguing the geometry of the human coronary arteries: a potential tool for predicting risk of coronary artery disease. 2009

Zhu, Hui / Ding, Zhaohua / Piana, Robert N / Gehrig, Thomas R / Friedman, Morton H. ·Department of Biomedical Engineering, Duke University, Durham, NC 27708-0281, USA. ·Int J Cardiol · Pubmed #18597872.

ABSTRACT: BACKGROUND: The non-uniform distribution of atherosclerosis in the human vasculature suggests that local fluid dynamics or wall mechanics may be involved in atherogenesis. Thus certain aspects of vascular geometry, which mediates both fluid dynamics and wall mechanics, might be risk factors for coronary atherosclerosis. Cataloguing the geometry of normal human coronary arteries and its variability is a first step toward identifying specific geometric features that increase vascular susceptibility to the disease. METHODS: Images of angiographically normal coronary arteries, including 32 left anterior descending (LAD) and 35 right coronary arteries (RCA), were acquired by clinical biplane cineangiography from 52 patients. The vessel axes in end diastole were reconstructed and geometric parameters that included measures of curvature, torsion and tortuosity were quantified for the proximal, middle and distal segments of the arteries. RESULTS: Statistical analysis shows that (1) in the LAD, curvature, torsion and tortuosity are generally highest in the distal portion, (2) in the RCA, these parameters are smallest in the middle segment, (3) the LAD exhibits significant higher torsion than the RCA (P < 0.005), and (4) >80% of the variability of coronary arterial geometry can be expressed in terms of two factors, one dominated by the curvature measures and tortuosity, and the other emphasizing the torsion parameters. CONCLUSIONS: This study has comprehensively documented the normal arterial geometry of the LAD and RCA in end diastole. This information may be used to guide the identification of geometric features that might be atherogenic risk factors.

8 Minor Response to letter regarding article, "The learning curve for transradial percutaneous coronary intervention among operators in the United States: a study from the National Cardiovascular Data Registry". 2015

Hess, Connie N / Peterson, Eric D / Neely, Megan L / Dai, David / Hillegass, William B / Krucoff, Mitchell W / Kutcher, Michael A / Messenger, John C / Pancholy, Samir / Piana, Robert N / Rao, Sunil V. ·Duke Clinical Research Institute, Durham, NC. · University of Alabama at Birmingham, Birmingham, AL. · Wake Forest University School of Medicine, Winston-Salem, NC. · University of Colorado School of Medicine, Aurora, CO. · The Wright Center for Graduate Medical Education, Scranton, PA. · Vanderbilt Heart Center, Nashville, TN. ·Circulation · Pubmed #25712065.

ABSTRACT: -- No abstract --