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Coronary Artery Disease: HELP
Articles by Andrés M. Pineda
Based on 7 articles published since 2008
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Between 2008 and 2019, Andres M. Pineda wrote the following 7 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Managing Multivessel Coronary Artery Disease in Patients With ST-Elevation Myocardial Infarction: A Comprehensive Review. 2017

Pineda, Andrés M / Carvalho, Nikita / Gowani, Saqib A / Desouza, Kavit A / Santana, Orlando / Mihos, Christos G / Stone, Gregg W / Beohar, Nirat. ·From the *Division of Cardiology, Columbia University, Mount Sinai Medical Center, Miami Beach, FL; and †Division of Cardiology, Columbia University Medical Center, New York, NY. ·Cardiol Rev · Pubmed #27124268.

ABSTRACT: Multivessel coronary artery disease (CAD) is found in up to 60% of the patients presenting with an ST-elevation myocardial infarction (STEMI) and worsens the prognosis proportional to the extent of CAD severity. However, the 2013 American College of Cardiology/American Heart Association STEMI guidelines, based on mostly observational data, had recommended against a routine noninfarct-related artery percutaneous coronary intervention (PCI). After these guidelines were published, a handful of randomized trials became available, and they suggested that PCI of significant lesions in a noninfarct-related artery at the time of primary PCI might result in improved patient outcomes. The incidence of major adverse cardiac events was significantly reduced by 55% at 1 year and 65% at 2 years in patients undergoing angiographically guided PCI of nonculprit vessels at the time of primary PCI, in 2 different randomized trials. Fractional flow reserve-guided PCI of nonculprit vessels in this setting has also been shown to reduce cardiac events by 44% at 1 year. Meta-analyses of both nonrandomized and randomized trials have also suggested that complete revascularization at the time of STEMI significantly improves outcomes, including long-term all-cause mortality. In view of the emerging data, a focused update on primary PCI was published in 2015 and suggested that PCI of noninfarct-related arteries might be considered in selected patients. This article is a comprehensive review of the literature on the treatment of multivessel CAD in patients with STEMI, which provides the reader a critical analysis of the available information to determine the best therapeutic approach.

2 Review The cardiovascular effects of colchicine: a comprehensive review. 2015

Casanova, Paola / Artola, Rosa T / Mihos, Christos G / Pineda, Andres M / Santana, Orlando. ·From the *Columbia University Division of Cardiology, The Mount Sinai Heart Institute, Mount Sinai Medical Center, Miami Beach, FL; and †Department of Internal Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL. ·Cardiol Rev · Pubmed #25688661.

ABSTRACT: Colchicine is used extensively in the treatment of autoimmune and inflammatory disorders. Recent data have demonstrated additional benefit in a variety of cardiovascular disorders, including acute and recurrent pericarditis, postpericardiotomy syndrome, atrial fibrillation, stable ischemic heart disease, and possibly chronic heart failure. This article serves as a focused and updated discussion on the cardiovascular effects of colchicine and emphasizes the importance of randomized, placebo-controlled trials to further our clinical and pharmacological understanding of these findings.

3 Article A Staged Approach of Proximal Left Anterior Descending Coronary Artery Percutaneous Intervention Followed by Minimally Invasive Valve Surgery. 2017

Pineda, Andrés M / Mihos, Christos G / Rodriguez-Escudero, Juan P / Lamelas, Joseph / Beohar, Nirat / Santana, Orlando. ·Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA. Electronic correspondence: andrespine@hotmail.com. · Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA. · Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA. · Department of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA. ·J Heart Valve Dis · Pubmed #29092117.

ABSTRACT: BACKGROUND AND AIM OF THE STUDY: A subset of patients requiring coronary revascularization of the proximal left anterior descending coronary artery (LAD) and valve surgery may benefit from a staged approach, rather than combined median sternotomy coronary artery bypass graft (CABG) and valve surgery. METHODS: A retrospective evaluation was made of the outcomes of patients with significant proximal LAD and valvular heart disease undergoing a staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) at the authors' institution between February 2009 and April 2014. A Kaplan-Meier analysis was performed to estimate mid-term survival. RESULTS: A total of 68 consecutive patients (mean age 75.2 ± 8.9 years) was identified. PCI was performed for one- or two-vessel disease in 76.5% and 23.5% of the patients, respectively. Within a median of 39 days (IQR 11-62 days), 91.2% of patients underwent primary MIVS, and 8.8% underwent re-operative MIVS, of which 58 (85.3%) were single-valve and 10 (14.7%) were double-valve operations. At the time of surgery, 72.1% of the patients were receiving dual anti-platelet therapy. The 30-day mortality was 2.9%. At a mean follow up of 26 ± 16 months, 7.4% of the patients had a non-target vessel acute coronary syndrome, and the survival rate was 88.2%. CONCLUSIONS: Among a select group of patients with proximal LAD and valvular disease, a staged approach of PCI followed by MIVS can be safely performed for primary or re-operative surgery, with excellent mid-term outcomes.

4 Article Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of PCI Followed by Minimally Invasive Valve Surgery. 2017

Pineda, Andrés M / Gowani, Saqib A / Mihos, Christos G / Chandra, Ramesh / Santana, Orlando / Lamelas, Joseph / Beohar, Nirat. ·From the *Columbia University Division of Cardiology and the †Department of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL USA. ·Innovations (Phila) · Pubmed #28129316.

ABSTRACT: OBJECTIVE: A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the combined coronary artery bypass graft and valve surgery for patients with concomitant coronary artery (CAD) and valvular heart disease. We sought to evaluate the impact of the complexity of CAD, as assessed by the Syntax score, on the outcomes of the staged approach. METHODS: We retrospectively evaluated 138 patients who underwent PCI and MIVS at our institution between January 2009 and June 2013. The baseline Syntax score was calculated, and the patients were divided into two groups: low risk (Syntax scores, 0-22) or intermediate-high risk (>22). RESULTS: There were 125 patients with low (mean ± standard deviation, 8 ± 5) and 13 with intermediate-high (mean ± standard deviation, 26 ± 4) Syntax scores. Baseline, PCI, and operative characteristics were similar between the groups, except for an observed higher incidence of peripheral arterial disease, multivessel coronary disease, mitral valve replacement, and a higher predicted The Society of Thoracic Surgeons mortality risk score in the intermediate-high Syntax group. The short-term postoperative complications, 30-day mortality, and 3-year survival (84% vs 77%) were similar between the groups. Patients in the intermediate-high-risk group had a higher incidence of repeat target vessel revascularization during follow-up (0.8% vs 16.7%). CONCLUSIONS: A staged approach of PCI followed by MIVS is a safe and feasible alternative for patients with valvular heart disease and concomitant CAD. However, it may confer an increased incidence of repeat target vessel revascularization in patients with intermediate- to high-complexity CAD.

5 Article Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease. 2016

Pineda, Andrés M / Chandra, Ramesh / Gowani, Saqib A / Santana, Orlando / Mihos, Christos G / Kirtane, Ajay J / Stone, Gregg W / Kurlansky, Paul / Smith, Craig R / Beohar, Nirat. ·Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida. · Columbia University Medical Center, New York, New York. · Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida. nirat.beohar@msmc.com. ·Catheter Cardiovasc Interv · Pubmed #26526421.

ABSTRACT: BACKGROUND: A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. METHODS: A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS. RESULTS: Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a median follow-up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05). CONCLUSIONS: In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow-up. © 2015 Wiley Periodicals, Inc.

6 Article Percutaneous Coronary Intervention Followed by Minimally Invasive Mitral Valve Surgery in Ischemic Mitral Regurgitation. 2015

Mihos, Christos G / Santana, Orlando / Pineda, Andrés M / Stone, Gregg W / Hasty, Frederick / Beohar, Nirat. ·From the *Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA; †Columbia University Medical Center, New York, NY USA; and ‡Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL USA. ·Innovations (Phila) · Pubmed #26655933.

ABSTRACT: OBJECTIVE: The optimal treatment strategy in patients with coronary artery disease and ischemic mitral regurgitation (IMR) remains controversial. A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery, rather than combined median sternotomy coronary artery bypass and valve surgery, may be a viable alternative. METHODS: We retrospectively evaluated 31 consecutive patients with coronary artery disease and severe IMR who underwent a staged procedure at our institution between February 2009 and April 2014. RESULTS: The mean ± SD age, preoperative left ventricular ejection fraction, and mitral regurgitation grade were 72 ± 7 years, 35% ± 11%, and 3.6 ± 0.6, respectively. The mean ± SD Society of Thoracic Surgeons-predicted mortality score was 5.1% ± 4.2%. Percutaneous coronary intervention was performed for 1- and 2-vessel disease in 22 patients (71%) and 9 patients (29%), respectively, with 23 patients (74%) having drug-eluting stents placed. Minimally invasive valve surgery was performed within a median of 36 days after PCI, with 61% of the patients being on dual antiplatelet therapy. Postoperatively, there was 1 case of acute kidney injury, 1 case of reoperation for bleeding, and no cerebrovascular accidents. The 30-day mortality was 3%. The median total hospital length of stay was 8 days (interquartile range, 7-10). At a mean ± SD follow-up of 2.4 ± 1.6 years, 2 patients required PCI for target-vessel revascularization. Actuarial survival at 1 and 5 years was 84% and 80%, respectively. CONCLUSIONS: A staged approach in patients with coronary artery disease and IMR can be performed with a low perioperative morbidity and good midterm survival.

7 Article Same-day discharge or overnight stay after percutaneous coronary intervention: comparison of net adverse cardiovascular events. 2014

Nascimento, Francisco O / Pineda, Andres M / Benjo, Alexandre / Mas, Ildefonso / Podesta, Carlos / Heimowitz, Todd B / Kirtane, Ajay / Beohar, Nirat. ·Columbia University, Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Road, Miami Beach, FL 33140 USA. fonasci@gmail.com. ·J Invasive Cardiol · Pubmed #24791718.

ABSTRACT: BACKGROUND: Same-day discharge after percutaneous coronary intervention (PCI), if achieved with acceptable safety, could result in greater patient satisfaction and potential cost savings. Comparative analyses reporting the safety outcomes of same-day discharge vs overnight stay after elective PCI are lacking. METHODS: Data of same-day discharge and overnight-stay patients undergoing elective PCI in a high-volume center were compared. We specifically evaluated the incidence of net adverse cardiovascular events (NACE; i.e., death, myocardial infarction, stroke, target vessel revascularization, vascular complication, and major bleeding) within 48 hours post index procedure among both groups and at 30 days. RESULTS: A total of 188 cases were evaluated, with 93 discharged the same day and 95 after overnight stay following elective PCI. Baseline characteristics were similar, except for older age (73.0 ± 7 years vs. 64.0 ± 12 years; P<.001), more prior PCI (49.5% vs. 34.7%; P<.001), and prior coronary artery bypass graft surgery (16.1% vs. 11.6%; P=.01) in the same-day discharge group. Procedural characteristics were similar in both groups. No significant difference in the NACE rate was found between the groups at 48 hours (0 [0%] vs. 2 [2.1%]; P=.25) or at 30 days (3 [3.2%] vs. 6 [6.3%]; P=.26). CONCLUSION: In the population studied, same-day discharge after PCI is safe and feasible. Adequately powered randomized prospective studies are necessary to confirm these results.