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Coronary Artery Disease: HELP
Articles by Sunil V. Rao
Based on 67 articles published since 2010
(Why 67 articles?)
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Between 2010 and 2020, Sunil V. Rao wrote the following 67 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
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 Complete Coronary Revascularization: The End Justifies the Means, as Long as Something Justifies the End. 2017

Rao, Sunil V. ·Duke Clinical Research Institute, Durham, North Carolina. Electronic address: sunil.rao@duke.edu. ·JACC Cardiovasc Interv · Pubmed #28728655.

ABSTRACT: -- No abstract --

3 Editorial Staying ahead of the curve. 2014

Rao, Sunil V / Cohen, Mauricio G. ·The Duke Clinical Research Institute, Durham, NC. Electronic address: sunil.rao@duke.edu. · University of Miami Miller School of Medicine, Miami, FL. ·Cardiovasc Revasc Med · Pubmed #24952683.

ABSTRACT: -- No abstract --

4 Editorial Isn't it about time we learned how to use blood transfusion in patients with ischemic heart disease? 2014

Rao, Sunil V / Sherwood, Matthew W. ·The Duke Clinical Research Institute, Durham, North Carolina. Electronic address: sunil.rao@duke.edu. · The Duke Clinical Research Institute, Durham, North Carolina. ·J Am Coll Cardiol · Pubmed #24361316.

ABSTRACT: -- No abstract --

5 Editorial Ischemia-driven revascularization: demonstrating and delivering a mature procedure in a mature way. 2013

Patel, Manesh R / Rao, Sunil V. · ·Circ Cardiovasc Qual Outcomes · Pubmed #23674312.

ABSTRACT: -- No abstract --

6 Editorial Evaluating the bite of the BARC. 2012

Rao, Sunil V / Mehran, Roxana. · ·Circulation · Pubmed #22344038.

ABSTRACT: -- No abstract --

7 Review Cath Lab Robotics: Paradigm Change in Interventional Cardiology? 2019

Wegermann, Zachary K / Swaminathan, Rajesh V / Rao, Sunil V. ·Division of Cardiology, Duke University Medical Center, Durham, NC, USA. zachary.wegermann@duke.edu. · Duke Clinical Research Institute, Durham, NC, USA. zachary.wegermann@duke.edu. · Division of Cardiology, Duke University Medical Center, Durham, NC, USA. · Duke Clinical Research Institute, Durham, NC, USA. ·Curr Cardiol Rep · Pubmed #31473815.

ABSTRACT: PURPOSE OF REVIEW: To review the contemporary evidence for robotic-assisted percutaneous coronary and vascular interventions, discussing its current capabilities, limitations, and potential future applications. RECENT FINDINGS: Robotic-assisted cardiovascular interventions significantly reduce radiation exposure and orthopedic strains for interventionalists, while maintaining high rates of device and clinical success. The PRECISE and CORA-PCI studies demonstrated the safety and efficacy of robotic-assisted percutaneous coronary intervention (PCI) in increasingly complex coronary lesions. The RAPID study demonstrated similar findings in peripheral vascular interventions (PVI). Subsequent studies have demonstrated the safety and efficacy of second-generation devices, with automations mimicking manual PCI techniques. While innovations such as telestenting continue to bring excitement to the field, major limitations remain-particularly the lack of randomized trials comparing robotic-assisted PCI with manual PCI. Robotic technology has successfully been applied to multiple cardiovascular procedures. There are limited data to evaluate outcomes with robotic-assisted PCI and other robotic-assisted cardiovascular procedures, but existing data show some promise of improving the precision of PCI while decreasing occupational hazards associated with radiation exposure.

8 Review "How can SCAI and industry partners increase adherence and educate interventionalists on optimal medical therapy?" 2019

Elmariah, Sammy / Rao, Sunil V / Grines, Cindy L / Garratt, Kirk N / Caputo, Ronald P / Henry, Timothy D / Naidu, Srihari S / Anonymous451080 / Bhalla, Narinder / Gagliardi, Bill / Venditto, John. ·Massachusetts General Hospital, Boston, MA, United States. · Duke University Hospital, Durham, Virginia, United States. · Northwell Health System, Manhasset, NY, United States. · Christiana Care Health System, Newark, DE, United States. · St. Joseph's Cardiovascular Specialists, Syracuse, New York, United States. · Cedars-Sinai Heart Institute, Los Angeles, CA, United States. · Westchester Medical Center, Valhalla, NY, United States. · AstraZeneca, Chadds Ford, PA, United States. · Janssen Pharmaceuticals, Raritan NJ, United States. · AstraZeneca, Wilmington, DE, United States. ·Catheter Cardiovasc Interv · Pubmed #30393971.

ABSTRACT: -- No abstract --

9 Review Cardiac allograft vasculopathy: A review. 2018

Lee, Michael S / Tadwalkar, Rigved V / Fearon, William F / Kirtane, Ajay J / Patel, Amisha J / Patel, Chetan B / Ali, Ziad / Rao, Sunil V. ·Division of Cardiology, UCLA Medical Center, Los Angeles, California. · Division of Cardiology, Stanford University School of Medicine, Stanford, California. · Division of Cardiology, Columbia University Medical Center, New York, New York. · Division of Cardiology, Duke University Medical Center, Durham, North Carolina. ·Catheter Cardiovasc Interv · Pubmed #30265435.

ABSTRACT: Cardiac allograft vasculopathy (CAV) is a complex disease that remains a significant cause of morbidity and mortality after orthotopic heart transplantation (OHT). Originating as a result of inflammatory response, the development and progression of CAV is attributed to endothelial dysfunction, cellular infiltration, and a wide-range of genetic and patient factors. The detection of CAV remains a diagnostic challenge, as symptoms can be variable or absent. While coronary angiography remains the initial test of choice for the diagnosis and surveillance of CAV, intravascular imaging (either by ultrasound or optical coherence tomography) and physiologic assessments are useful adjuncts in the cardiac catheterization laboratory. Positron emission tomography, computed tomographic, and magnetic resonance imaging may have a role increasing the time interval between invasive screening tests for prognosis. Medical management should include a statin, vasodilator, and tailored immunosuppressive regimen that maximally decrease allograft rejection and CAV progression while causing minimal side effects. Patients that are less responsive to pharmacotherapy should be considered for invasive management with percutaneous coronary intervention. Although surgical revascularization is a poor option, repeat OHT is the only definitive treatment option but given its morbidity should be reserved for a highly selected patient population.

10 Review Anemia and coronary artery disease: pathophysiology, prognosis, and treatment. 2018

Rymer, Jennifer A / Rao, Sunil V. ·Department of Medicine, Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA. ·Coron Artery Dis · Pubmed #29280914.

ABSTRACT: The mechanisms, pathophysiology, and treatment of anemia in coronary artery disease (CAD) are complex. The hemodynamic changes found in the acute anemic state may contribute to progressive arterial wall and left ventricular hypertrophy if the anemic state persists chronically. We will examine the evidence for anemia as an independent risk factor for CAD events and cardiovascular mortality after percutaneous coronary intervention. We will also investigate the thresholds for appropriate blood transfusion in patients with CAD, as well as the cardiovascular outcomes associated with the utilization of a liberal versus conservative blood transfusion strategy. Although there is evidence supporting the use of intravenous iron replacement in patients with congestive heart failure, we will demonstrate the lack of evidence for iron replacement in patients with CAD. Finally, we will examine the evidence for increased cardiovascular mortality and venous thromboembolic events with the use of erythropoietin-stimulating agents in patients with CAD.

11 Review Outcomes of Saphenous Vein Graft Intervention With and Without Embolic Protection Device: A Comprehensive Review and Meta-Analysis. 2017

Paul, Timir K / Bhatheja, Samit / Panchal, Hemang B / Zheng, Shimin / Banerjee, Subhash / Rao, Sunil V / Guzman, Luis / Beohar, Nirat / Zhao, David / Mehran, Roxana / Mukherjee, Debabrata. ·From the Division of Cardiology, Department of Internal Medicine (T.K.P., H.B.P.) and Department of Biostatistics and Epidemiology, College of Public Health (S.Z.), East Tennessee State University, Johnson City · The Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.B., R.M.) · VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas (S.B.) · The Duke Clinical Research Institute, Durham, NC (S.V.R.) · Virginia Commonwealth University, Richmond (L.G.) · Nirat Beohar, Columbia University Division of Cardiology at the Mount Sinai Medical Center, Miami Beach, FL (N.B.) · Wake Forest University, Winston-Salem, NC (D.Z.) · and Division of Cardiology, Department of Internal Medicine, Texas Tech University, El Paso (D.M.). ·Circ Cardiovasc Interv · Pubmed #29246912.

ABSTRACT: BACKGROUND: Current guidelines give a class I recommendation to use of embolic protection devices (EPD) for saphenous vein graft (SVG) intervention; however, studies have shown conflicting results. The objective of this meta-analysis is to compare all-cause mortality, major adverse cardiovascular events, myocardial infarction (MI), or target vessel revascularization in SVG intervention with and without EPD. METHODS AND RESULTS: Literature was searched through October 2016. Eight studies (n=52 893) comparing SVG intervention performed with EPD (n=11 506) and without EPD (n=41 387) were included. There was no significant difference in all-cause mortality (odds ratio [OR], 0.79; confidence interval [CI], 0.55-1.12; CONCLUSIONS: This study including 52 893 patients suggests no apparent benefit in routine use of EPD during SVG intervention in the contemporary real-world practice. Further randomized clinical trials are needed in current era to evaluate long-term outcomes in routine use of EPD, and meanwhile, current guideline recommendations on EPD use should be revisited.

12 Review Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. 2017

Shlofmitz, Evan / Martinsen, Brad J / Lee, Michael / Rao, Sunil V / Généreux, Philippe / Higgins, Joe / Chambers, Jeffrey W / Kirtane, Ajay J / Brilakis, Emmanouil S / Kandzari, David E / Sharma, Samin K / Shlofmitz, Richard. ·a Division of Cardiology , Columbia University Medical Center , New York , NY , USA. · b Cardiovascular Research Foundation , New York , NY , USA. · c Department of Clinical and Scientific Affairs , Cardiovascular Systems, Inc. , St. Paul , MN , USA. · d Division of Cardiology , UCLA Medical Center , Los Angeles , CA , USA. · e Duke Clinical Research Institute , Durham , NC , USA. · f Morristown Medical Center , Morristown , NJ , USA. · g Hôpital du Sacré-Coeur de Montréal , Université de Montréal , Montréal , Canada. · h Department of Engineering , Cardiovascular Systems, Inc ., St. Paul , MN , USA. · i Metropolitan Heart and Vascular Institute , Mercy Hospital , Minneapolis , MN , USA. · j Minneapolis Heart Institute , Abbott Northwestern Hospital , Minneapolis , MN , USA. · k Piedmont Heart Institute , Atlanta , GA , USA. · l Division of Cardiology , Mount Sinai Hospital , New York , NY , USA. · m Department of Cardiology , St. Francis Hospital-The Heart Center , Roslyn , NY , USA. ·Expert Rev Med Devices · Pubmed #28945162.

ABSTRACT: INTRODUCTION: The presence of severe coronary artery calcification is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with non-calcified lesions. Incorporating orbital atherectomy (OAS) for effective preparation of severely calcified lesions can help maximize the benefits of PCI by attaining maximal luminal gain (or stent expansion) and improve long-term outcomes (by reducing need for revascularization). Areas covered: In this manuscript, the prevalence, risk factors, and impact of coronary artery calcification on PCI are reviewed. Based on current data and experience, the authors review orbital atherectomy technique and best practices to optimize lesion preparation. Expert Commentary: The coronary OAS is the only device approved for use in the U.S. as a treatment for de novo, severely calcified coronary lesions to facilitate stent delivery. Advantages of the device include its ease of use and a mechanism of action that treats bi-directionally, allowing for continuous blood flow during treatment, minimizing heat damage, slow flow, and subsequent need for revascularization. The OAS technique tips reviewed in this article will help inform interventional cardiologists treating patients with severely calcified lesions.

13 Review Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. 2017

Garg, Aakash / Rao, Sunil V / Agrawal, Sahil / Theodoropoulos, Kleanthis / Mennuni, Marco / Sharma, Abhishek / Garg, Lohit / Ferrante, Giuseppe / Meelu, Omar A / Sargsyan, Davit / Reimers, Bernhard / Cohen, Marc / Kostis, John B / Stefanini, Giulio G. ·Department of Medicine, St. Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Division of Cardiology, Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. Electronic address: drgarg.aakash@gmail.com. · Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina. · Division of Cardiology, St. Luke's University Hospital, Bethlehem, Pennsylvania. · Department of Medicine, James J. Peters Veterans Affairs Medical Center, Bronx, New York. · Division of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy. · Department of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York. · Division of Cardiology, Lehigh Valley Hospital, Allentown, Pennsylvania. · Division of Cardiology, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Hospital, New York, New York. · Division of Cardiology, Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. · Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey. · Division of Cardiology, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy. ·Am J Cardiol · Pubmed #28433215.

ABSTRACT: Few randomized controlled trials (RCTs) and observational studies had shown acceptable short-term efficacy and safety of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) in selected patients with left main coronary artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI using DES compared with CABG in patients with LMCAD. On November 1, 2016, we searched available databases for published RCTs directly comparing DES PCI with CABG in patients with LMCAD. Odds ratios (ORs) were used as the metric of choice for treatment effects using a random-effects model. I-squared index was used to assess heterogeneity across trials. Prespecified end points were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and repeat revascularization at maximal available follow-up. We identified 5 RCTs including a total of 4,595 patients, with a median follow-up of 60 months. The risk of all-cause mortality (OR 1.01; 95% confidence interval [CI] 0.76 to 1.34) and cardiovascular mortality (OR 1.02; 95% CI 0.73 to 1.42) were comparable between PCI with DES and CABG. Similarly, there were no statistically significant differences between PCI with DES and CABG for MI (OR 1.45; 95% CI 0.87 to 2.40) and stroke (OR 0.87; 95% CI 0.38 to 1.98). Conversely, repeat revascularization was significantly higher with PCI compared with CABG (OR 1.82; 95% CI 1.51 to 2.21). In conclusion, in patients with LMCAD, PCI with DES appears to be a viable alternative to CABG at long-term follow-up, with similar risks of ischemic adverse events (mortality, MI, and stroke) but a higher risk of repeat revascularization.

14 Review Polymer-Free Drug-Coated Coronary Stents in Patients with Stable Coronary Artery Disease at High Bleeding Risk. 2017

Panchal, Hemang B / Daggubati, Ramesh / Zhao, David / Rao, Sunil V / Paul, Timir. ·Division of Cardiology, Department of Internal Medicine, East Tennessee State University, 329 North State of Franklin Rd, Johnson City, TN, USA. · Division of Cardiology, Winthrop University Hospital, 259 First Street, Mineola, NY, 11501, USA. · Section on Cardiovascular Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA. · Duke University Medical Center, Durham VA Medical Center, 508 Fulton Street (111A), Durham, NC, 27705, USA. · Department of Internal Medicine, Cardiovascular Research, East Tennessee State University, 329 North State of Franklin Rd, Johnson City, TN, USA. pault@etsu.edu. ·Curr Cardiol Rep · Pubmed #28185168.

ABSTRACT: PURPOSE OF REVIEW: Patients with stable coronary artery disease (CAD) and a high risk of bleeding are not ideal candidates for a polymer-based drug-eluting stent (DES) because it requires 6-12 months of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). The purpose of this review is to assess the angiographic and clinical outcomes of polymer-free drug-coated stents (PF-DCS) in stable CAD patients with a high bleeding risk. RECENT FINDINGS: Several randomized controlled trials (RCTs) have compared angiographic and clinical outcomes of PF-DCS with bare-metal stents (BMS), permanent polymer (PP)-DES, or biodegradable polymer (BP)-DES. However, none of these studies particularly recruited patients with stable CAD and a high risk of bleeding. Furthermore, there are limited data available on duration of DAPT following PF-DCS placement. PF-DCS has a better efficacy and similar safety as compared with BMS. PF-DCS with dual drug is noninferior to currently available PP-DES. Further RCTs are needed to assess the safety and efficacy of PF-DCS to BP-DES and PP-DES comparing shorter to standard durations of DAPT.

15 Review The Changing Landscape of Randomized Clinical Trials in Cardiovascular Disease. 2016

Jones, W Schuyler / Roe, Matthew T / Antman, Elliott M / Pletcher, Mark J / Harrington, Robert A / Rothman, Russell L / Oetgen, William J / Rao, Sunil V / Krucoff, Mitchell W / Curtis, Lesley H / Hernandez, Adrian F / Masoudi, Frederick A. ·Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: schuyler.jones@duke.edu. · Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. · TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. · Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco, California. · Department of Medicine, Stanford University School of Medicine, Stanford, California. · Departments of Medicine and Pediatrics, Vanderbilt University, Nashville, Tennessee. · American College of Cardiology, Washington, DC. · Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. ·J Am Coll Cardiol · Pubmed #27765193.

ABSTRACT: Large randomized clinical trials in cardiovascular disease have proliferated over the past 3 decades, with results that have influenced every aspect of cardiology practice. Despite these advances, there remains a substantial need for more high-quality evidence to inform cardiovascular clinical practice, given the increasing prevalence of cardiovascular disease around the world. Traditional clinical trials are increasingly challenging due to rising costs, increasing complexity and length, and burdensome institutional and regulatory requirements. This review will examine the current landscape of cardiovascular clinical trials in the United States, highlight recently conducted registry-based clinical trials, and discuss the potential attributes of the recently launched pragmatic clinical trial by the Patient-Centered Outcomes Research Institute's National Patient-Centered Clinical Research Network, called the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing the Benefits and Long-term Effectiveness) trial.

16 Review Meta-Analysis Comparing Complete Revascularization Versus Infarct-Related Only Strategies for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. 2016

Shah, Rahman / Berzingi, Chalak / Mumtaz, Mubashir / Jasper, John B / Goswami, Rohan / Morsy, Mohamed S / Ramanathan, Kodangudi B / Rao, Sunil V. ·Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee; Veterans Affairs Medical Center, Memphis, Tennessee. Electronic address: Shahcardiology@yahoo.com. · West Virginia University Heart Institute, Morgantown, West Virginia. · Pinnacle Health, Wormleysburg, Pennsylvania. · Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee. · Section of Cardiology, School of Medicine, University of Tennessee, Memphis, Tennessee; Veterans Affairs Medical Center, Memphis, Tennessee. · The Duke Clinical Research Institute, Durham, North Carolina. ·Am J Cardiol · Pubmed #27642115.

ABSTRACT: Several recent randomized controlled trials (RCTs) demonstrated better outcomes with multivessel complete revascularization (CR) than with infarct-related artery-only revascularization (IRA-OR) in patients with ST-segment elevation myocardial infarction. It is unclear whether CR should be performed during the index procedure (IP) at the time of primary percutaneous coronary intervention (PCI) or as a staged procedure (SP). Therefore, we performed a pairwise meta-analysis using a random-effects model and network meta-analysis using mixed-treatment comparison models to compare the efficacies of 3 revascularization strategies (IRA-OR, CR-IP, and CR-SP). Scientific databases and websites were searched to find RCTs. Data from 9 RCTs involving 2,176 patients were included. In mixed-comparison models, CR-IP decreased the risk of major adverse cardiac events (MACEs; odds ratio [OR] 0.36, 95% CI 0.25 to 0.54), recurrent myocardial infarction (MI; OR 0.50, 95% CI 0.24 to 0.91), revascularization (OR 0.24, 95% CI 0.15 to 0.38), and cardiovascular (CV) mortality (OR 0.44, 95% CI 0.20 to 0.87). However, only the rates of MACEs, MI, and CV mortality were lower with CR-SP than with IRA-OR. Similarly, in direct-comparison meta-analysis, the risk of MI was 66% lower with CR-IP than with IRA-OR, but this advantage was not seen with CR-SP. There were no differences in all-cause mortality between the 3 revascularization strategies. In conclusion, this meta-analysis shows that in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease, CR either during primary PCI or as an SP results in lower occurrences of MACE, revascularization, and CV mortality than IRA-OR. CR performed during primary PCI also results in lower rates of recurrent MI and seems the most efficacious revascularization strategy of the 3.

17 Review The choice of arterial access for percutaneous coronary intervention and its impact on outcome: An expert opinion perspective. 2015

Baker, Nevin C / Ansel, Gary M / Rao, Sunil V / Jolly, Sanjit S / Pichard, Augusto D / Steinberg, Daniel / Lipinski, Michael J / Escarcega, Ricardo O / Minha, Sa'ar / Lhermusier, Thibault / Magalhães, Marco A / Waksman, Ron. ·Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. · OhioHealth Heart & Vascular Physicians, Columbus, OH. · Division of Cardiology, Duke University, Durham, NC. · Division of Cardiology, McMaster University, Ontario, Canada. · Division of Cardiology, Medical University of South Carolina, Charleston, SC. · Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net. ·Am Heart J · Pubmed #26093860.

ABSTRACT: The prevention of major bleeding during percutaneous coronary intervention is one of the most widely discussed and often controversial topics within interventional cardiology. The choice of arterial access should be considered a mechanism for bleeding avoidance, and various strategies have been proposed to prevent or lower major bleeding and vascular complications with varying levels of strength. Herein, we review the current literature on arterial access as a bleeding avoidance strategy during percutaneous coronary intervention and its impact on outcome and provide a consensus opinion based on the strength of the evidence supporting various techniques.

18 Review Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review. 2014

Lee, Michael S / Applegate, Bob / Rao, Sunil V / Kirtane, Ajay J / Seto, Arnold / Stone, Gregg W. ·Division of Cardiology, UCLA Medical Center, Los Angeles, California. ·Catheter Cardiovasc Interv · Pubmed #24677734.

ABSTRACT: Major bleeding complications after percutaneous coronary intervention (PCI) increase patient morbidity, prolong the hospital stay and costs, and are associated with reduced survival. Transfemoral access is still preferred at many centers given its familiarity and ease of use and is necessary in cases where large bore access is needed. Multimodality imaging with fluoroscopy, ultrasonography, and angiography can facilitate proper puncture of the common femoral artery. A proper technique (which includes femoral artery puncture and vascular access site closure) associated with adequate pharmacotherapy (both during PCI and peri-procedural, for the treatment of the underlying coronary artery disease) has been shown to reduce the risk of bleeding and vascular complications associated with femoral artery access. Avoiding the use of arterial sheaths >6 French may further reduce the risk of bleeding. Data with vascular closure devices as a bleeding avoidance strategy are evolving but when used appropriately may further reduce the risk of bleeding and vascular access complications, and in this regard are synergistic with bivalirudin. Randomized trials to confirm these recommendations are needed.

19 Review Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients. 2014

Harskamp, Ralf E / Bagai, Akshay / Halkos, Michael E / Rao, Sunil V / Bachinsky, William B / Patel, Manesh R / de Winter, Robbert J / Peterson, Eric D / Alexander, John H / Lopes, Renato D. ·Duke Clinical Research Institute and Duke University Medical Center, Durham, NC; Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. Electronic address: r.e.harskamp@gmail.com. · St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. · Emory University School of Medicine, Atlanta, GA. · Duke Clinical Research Institute and Duke University Medical Center, Durham, NC. · Pinnacle Health Cardiovascular Institute, Harrisburg Hospital, Harrisburg, PA. · Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. ·Am Heart J · Pubmed #24655709.

ABSTRACT: BACKGROUND: Hybrid coronary revascularization (HCR) represents a minimally invasive revascularization strategy in which the durability of the internal mammary artery to left anterior descending artery graft is combined with percutaneous coronary intervention to treat remaining lesions. We performed a systematic review and meta-analysis to compare clinical outcomes after HCR with conventional coronary artery bypass graft (CABG) surgery. METHODS: A comprehensive EMBASE and PUBMED search was performed for comparative studies evaluating in-hospital and 1-year death, myocardial infarction (MI), stroke, and repeat revascularization. RESULTS: Six observational studies (1 case control, 5 propensity adjusted) comprising 1,190 patients were included; 366 (30.8%) patients underwent HCR (185 staged and 181 concurrent), and 824 (69.2%) were treated with CABG (786 off-pump, 38 on-pump). Drug-eluting stents were used in 328 (89.6%) patients undergoing HCR. Hybrid coronary revascularization was associated with lower in-hospital need for blood transfusions, shorter length of stay, and faster return to work. No significant differences were found for the composite of death, MI, stroke, or repeat revascularization during hospitalization (odds ratio 0.63, 95% CI 0.25-1.58, P = .33) and at 1-year follow-up (odds ratio 0.49, 95% CI 0.20-1.24, P = .13). Comparisons of individual components showed no difference in all-cause mortality, MI, or stroke, but higher repeat revascularization among patients treated with HCR. CONCLUSIONS: Hybrid coronary revascularization is associated with lower morbidity and similar in-hospital and 1-year major adverse cerebrovascular or cardiac events rates, but greater requirement for repeat revascularization compared with CABG. Further exploration of this strategy with adequately powered randomized trials is warranted.

20 Review Radial versus femoral access. 2013

Rao, Sunil V / Turi, Zoltan G / Wong, S Chiu / Brener, Sorin J / Stone, Gregg W. · ·J Am Coll Cardiol · Pubmed #24135659.

ABSTRACT: -- No abstract --

21 Clinical Trial Rationale and design of the randomized, double-blind trial testing INtraveNous and Oral administration of elinogrel, a selective and reversible P2Y(12)-receptor inhibitor, versus clopidogrel to eVAluate Tolerability and Efficacy in nonurgent Percutaneous Coronary Interventions patients (INNOVATE-PCI). 2010

Leonardi, Sergio / Rao, Sunil V / Harrington, Robert A / Bhatt, Deepak L / Gibson, C Michael / Roe, Matthew T / Kochman, Janusz / Huber, Kurt / Zeymer, Uwe / Madan, Mina / Gretler, Daniel D / McClure, Matthew W / Paynter, Gayle E / Thompson, Vivian / Welsh, Robert C. ·Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. sergio.leonardi@duke.edu ·Am Heart J · Pubmed #20598974.

ABSTRACT: Despite current dual-antiplatelet therapy with aspirin and clopidogrel, adverse clinical events continue to occur during and after percutaneous coronary intervention (PCI). The failure of clopidogrel to provide optimal protection may be related to delayed onset of action, interpatient variability in its effect, and an insufficient level of platelet inhibition. Furthermore, the irreversible binding of clopidogrel to the P2Y(12) receptor for the life span of the platelet is associated with increased bleeding risk especially during urgent or emergency surgery. Novel antiplatelet agents are required to improve management of patients undergoing PCI. Elinogrel is a potent, direct-acting (ie, non-prodrug), selective, competitive, and reversible P2Y(12) inhibitor available in both intravenous and oral formulations. The INNOVATE-PCI study is a phase 2 randomized, double-blind, clopidogrel-controlled trial to evaluate the safety, tolerability, and preliminary efficacy of this novel antiplatelet agent in patients undergoing nonurgent PCI.

22 Clinical Trial Evaluation of a new heparin agent in percutaneous coronary intervention: results of the phase 2 evaluation of M118 IN pErcutaNeous Coronary intErvention (EMINENCE) Trial. 2010

Rao, Sunil V / Melloni, Chiara / Myles-Dimauro, Shelley / Broderick, Samuel / Kosinski, Andrzej S / Kleiman, Neal S / Dzavík, Vladimír / Tanguay, Jean Francois / Chandna, Harish / Gammon, Roger / Rivera, Ernesto / Alexander, John H / Fier, Ian / Roach, James / Becker, Richard C / Anonymous3900657. ·Duke Clinical Research Institute, Durham, NC, USA. sunil.rao@duke.edu ·Circulation · Pubmed #20368520.

ABSTRACT: BACKGROUND: Factor Xa and factor IIa (thrombin) play roles in thrombotic complications after percutaneous coronary intervention. M118 is a novel low-molecular-weight heparin that has been rationally designed to capture the desired attributes of unfractionated heparin (UFH) and low-molecular-weight heparin: Potent activity against factor Xa and IIa, predictable pharmacokinetics after both intravenous and subcutaneous administration, ability to be monitored by use of point-of-care coagulation assays, and reversibility with protamine sulfate. We performed a phase 2 randomized trial to evaluate the safety and feasibility of M118 in the setting of elective percutaneous coronary intervention. METHODS AND RESULTS: Overall, 503 patients undergoing elective percutaneous coronary intervention at 43 centers in the United States and Canada were randomized in an open-label fashion to 1 of 4 arms: UFH 70 U/kg, M118 50 IU/kg IV, M118 75 IU/kg IV, or M118 100 IU/kg IV. The primary outcome was the composite of death, myocardial infarction, repeat revascularization, stroke, thrombocytopenia, catheter thrombus, bailout use of glycoprotein IIb/IIIa inhibitor, or any bleeding through 30 days. The primary end point occurred in 31.1% of patients randomized to UFH and in 22.7%, 28.3%, and 30.1% of patients randomized to M118 50, 75, and 100 IU/kg, respectively. The primary analysis comparing the rates of the primary end points between the pooled M118 groups versus UFH demonstrated that M118 was noninferior to UFH at preventing percutaneous coronary intervention-related complications (28.4% pooled M118 arms versus 31.1% UFH). The adverse event profiles of M118 and UFH were comparable. CONCLUSIONS: This phase 2 randomized trial demonstrates that M118 is well tolerated and feasible to use as an anticoagulant in patients undergoing elective percutaneous coronary intervention and forms the basis for further investigation of this agent in ischemic heart disease. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00543400.

23 Article Complete Revascularization with Multivessel PCI for Myocardial Infarction. 2019

Mehta, Shamir R / Wood, David A / Storey, Robert F / Mehran, Roxana / Bainey, Kevin R / Nguyen, Helen / Meeks, Brandi / Di Pasquale, Giuseppe / López-Sendón, Jose / Faxon, David P / Mauri, Laura / Rao, Sunil V / Feldman, Laurent / Steg, P Gabriel / Avezum, Álvaro / Sheth, Tej / Pinilla-Echeverri, Natalia / Moreno, Raul / Campo, Gianluca / Wrigley, Benjamin / Kedev, Sasko / Sutton, Andrew / Oliver, Richard / Rodés-Cabau, Josep / Stanković, Goran / Welsh, Robert / Lavi, Shahar / Cantor, Warren J / Wang, Jia / Nakamya, Juliet / Bangdiwala, Shrikant I / Cairns, John A / Anonymous3201166. ·From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.R.M., H.N., B.M., T.S., N.P.-E., J.N., J.W., S.I.B.), the University of British Columbia, Vancouver (D.A.W., J.A.C.), the University of Alberta, Mazankowski Alberta Heart Institute, Edmonton (K.R.B., R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City (J.R.-C.), the University of Western Ontario, London Health Sciences Centre, London (S.L.), and the University of Toronto, Toronto Southlake Regional Health Centre, Toronto (W.J.C.) - all in Canada · the Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield (R.F.S.), the Royal Wolverhampton Hospitals NHS Trust, Wolverhampton (B.W.), the University Clinic of Cardiology, South Tees Hospitals NHS Foundation Trust, Middlesbrough (A.S.), and Hull University Teaching Hospitals NHS Trust, Hull (R.O.) - all in the United Kingdom · the Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.) · Ospedale Maggiore, Bologna (G.D.P.), the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (G.C.), and Maria Cecilia Hospital, GVM Care and Research, Cotignola (G.C.) - all in Italy · University Hospital La Paz, Madrid (J.L.-S., R.M.) · Brigham and Women's Hospital and Harvard Medical School, Boston (D.P.F., L.M.) · Duke University Medical Center, Durham, NC (S.V.R.) · Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris (L.F., P.G.S.) · Hospital Alemão Oswaldo Cruz, Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.) · the University Clinic of Cardiology, University St. Cyril and Methodius, Skopje, Macedonia (S.K.) · and the Clinical Center of Serbia, Belgrade (G.S.). ·N Engl J Med · Pubmed #31475795.

ABSTRACT: BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) of the culprit lesion reduces the risk of cardiovascular death or myocardial infarction. Whether PCI of nonculprit lesions further reduces the risk of such events is unclear. METHODS: We randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. Randomization was stratified according to the intended timing of nonculprit-lesion PCI (either during or after the index hospitalization). The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. RESULTS: At a median follow-up of 3 years, the first coprimary outcome had occurred in 158 of the 2016 patients (7.8%) in the complete-revascularization group as compared with 213 of the 2025 patients (10.5%) in the culprit-lesion-only PCI group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004). The second coprimary outcome had occurred in 179 patients (8.9%) in the complete-revascularization group as compared with 339 patients (16.7%) in the culprit-lesion-only PCI group (hazard ratio, 0.51; 95% CI, 0.43 to 0.61; P<0.001). For both coprimary outcomes, the benefit of complete revascularization was consistently observed regardless of the intended timing of nonculprit-lesion PCI (P = 0.62 and P = 0.27 for interaction for the first and second coprimary outcomes, respectively). CONCLUSIONS: Among patients with STEMI and multivessel coronary artery disease, complete revascularization was superior to culprit-lesion-only PCI in reducing the risk of cardiovascular death or myocardial infarction, as well as the risk of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. (Funded by the Canadian Institutes of Health Research and others; COMPLETE ClinicalTrials.gov number, NCT01740479.).

24 Article Examining the Operator Learning Curve for Percutaneous Coronary Intervention of Chronic Total Occlusions. 2019

Young, Michael N / Secemsky, Eric A / Kaltenbach, Lisa A / Jaffer, Farouc A / Grantham, James A / Rao, Sunil V / Yeh, Robert W. ·Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (M.N.Y.). · Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (E.A.S., R.W.Y.). · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (L.A.K., S.V.R.). · Cardiology Division, Massachusetts General Hospital, Boston (F.A.J.). · St Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (J.A.G.). ·Circ Cardiovasc Interv · Pubmed #31416356.

ABSTRACT: BACKGROUND: Advances in chronic total occlusion percutaneous coronary intervention (CTO PCI) techniques have led to increased procedural success rates among operators. While utilization of CTO PCI has disseminated widely, the learning curve for new operators has not been well-defined. METHODS: Between July 2009 and December 2015, 93 875 CTO PCI cases were extracted from the CathPCI Registry. We delineated a cohort of new CTO operators performing <10 CTO PCI cases per given year. In-hospital outcomes for subsequent CTO PCIs were stratified by the number of prior cases accrued by each operator. Multivariable regression models were used to estimate differences in outcomes with increasing experience. The primary outcome was major adverse cardiovascular events defined as the composite of death, myocardial infarction, stroke, tamponade, or urgent coronary artery bypass grafting. RESULTS: Among 70 916 cases performed by 7251 new operators, procedure success rate was 61.4% and major adverse cardiovascular event rate was 4.2%. Meanwhile, the rate of major bleeding was 4.0%, myocardial infarction 2.0%, mortality 0.6%, tamponade 0.3%, and renal failure 0.2%. Adjusted regression models demonstrated piecewise linear improvements in guidewire crossing, stent placement, and procedure success with accrued volume, albeit with increased contrast use, fluoroscopy time, and bleeding. Major adverse cardiovascular event rates were stable beyond the 12th case (odds ratio per 5 case increase 1.00; 95% CI, 0.98-1.03, P=0.7980). CONCLUSIONS: Among a large number of new CTO PCI operators in the United States, there exists an experiential learning curve for procedural success. However, there were higher rates of bleeding despite case experience, while major adverse cardiovascular events remained relatively unchanged after initiation.

25 Article The OPTIMIZE randomized trial to assess safety and efficacy of the Svelte IDS and RX Sirolimus-eluting coronary stent Systems for the Treatment of atherosclerotic lesions: Trial design and rationale. 2019

Mauri, Laura / Doros, Gheorghe / Rao, Sunil V / Cohen, David J / Yakubov, Steven / Lasala, John / Wong, S Chiu / Zidar, James / Kereiakes, Dean J. ·Harvard Medical School. · Baim Institute for Clinical Research; Department of Biostatistics, Boston University. · The Duke Clinical Research Institute. · Saint Luke's Mid America Heart Institute, Kansas City, MO. · OhioHealth Riverside Methodist Hospital. · Washington University School of Medicine in St. Louis. · Weil Cornell Medicine. · University of North Carolina. · The Christ Hospital and Lindner Research Center. Electronic address: Lindner@thechristhospital.com. ·Am Heart J · Pubmed #31415994.

ABSTRACT: Coronary stenting without angioplasty pretreatment (direct stenting) may simplify procedures in appropriate lesions. Direct stenting is facilitated by smaller profile coronary stent platforms. The present study was designed for regulatory approval of a novel drug-eluting coronary stent and incorporates both randomized comparison for non-inferiority to an approved predicate device as well as a nested evaluation of subjects eligible for direct stenting. STUDY DESIGN AND OBJECTIVES: Prospective, single-blind, randomized, active-control, multi-center study designed to assess the safety and efficacy of the novel Svelte sirolimus-eluting stent (SES) systems. A total of 1630 subjects with up to 3 target lesions will be randomized 1:1 to the Svelte SES versus either the Xience or Promus everolimus-eluting stents (control). Randomization will be stratified by whether or not a direct stenting strategy is planned by the investigator. The primary endpoint is target lesion failure (TLF) at 12 months post index procedure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization, and the primary analysis is a non-inferiority test with a non-inferiority margin of 3.58%. Secondary clinical endpoints include individual components of TLF, stent thrombosis and measures of procedural resource utilization including contrast administration, fluoroscopy exposure and procedural resource utilization as well as costs. CONCLUSION: The OPTMIZE Trial will evaluate the safety, efficacy and clinical value of the novel Svelte SES in subjects with up to 3 lesions, and will provide a comparison of direct stenting between randomized devices.

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