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Coronary Artery Disease: HELP
Articles by Benjamin M. Scirica
Based on 11 articles published since 2009
(Why 11 articles?)
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Between 2009 and 2019, Benjamin M. Scirica wrote the following 11 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Review Coronary computed tomographic angiography in the emergency room: state of the art. 2014

Cheezum, Michael K / Bittencourt, Marcio S / Hulten, Edward A / Scirica, Benjamin M / Villines, Todd C / Blankstein, Ron. ·Departments of Medicine and Radiology (Cardiovascular Division), Brigham and Women's Hospital, Non-Invasive Cardiovascular Imaging Program, Boston, MA, USA. ·Expert Rev Cardiovasc Ther · Pubmed #24417341.

ABSTRACT: Chest pain is a common complaint in the emergency department often necessitating testing to exclude underlying obstructive coronary artery disease. While the traditional evaluation of patients with suspected acute coronary syndrome often consists of serial electrocardiograms and cardiac biomarkers, followed by selective use of stress testing for further risk stratification, this approach is costly and inefficient. Recently, coronary computed tomographic angiography (CTA) has offered an alternative approach with a high sensitivity and negative predictive value to exclude obstructive coronary artery disease that can rapidly identify patients with low rates of downstream major adverse cardiac events. In this review, the authors provide an overview of available data on the use of CTA for evaluating acute chest pain, while emphasizing its advantages and disadvantages compared to existing strategies. In addition, we provide a suggested algorithm to identify how CTA can be incorporated into the evaluation of acute chest pain and discuss tips for successful implementation of CTA in the emergency department.

2 Review The clinical significance of continuous ECG (ambulatory ECG or Holter) monitoring of the ST-segment to evaluate ischemia: a review. 2013

Wimmer, Neil J / Scirica, Benjamin M / Stone, Peter H. ·Division of Cardiovascular Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. ·Prog Cardiovasc Dis · Pubmed #24215751.

ABSTRACT: Silent ischemia is a common manifestation of coronary artery disease (CAD). Continuous ECG (cECG) monitoring is an effective tool for assessing the frequency and duration of silent ischemic episodes for patients with CAD and for risk stratifying asymptomatic patients or those after an acute coronary syndrome by identifying those at increased risk for future cardiovascular events or death. cECG also allows monitoring of the effectiveness of therapy in patients with CAD. Treatment strategies targeted toward the elimination of silent ischemia have shown that revascularization was better than medical therapy in eliminating silent ischemia, but large scale, prospective studies targeting silent ischemia as a treatment endpoint are still lacking. Future research is warranted to study the effects of newer medical agents or the selected use of revascularization in those patients with persistent silent ischemia despite current medical regiments.

3 Review Chronic angina: definition, prevalence, and implications for quality of life. 2009

Scirica, Benjamin M. ·TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. ·Rev Cardiovasc Med · Pubmed #19898285.

ABSTRACT: Chronic angina is a prevalent manifestation of cardiovascular disease and is most commonly due to insufficient oxygen supply from fixed epicardial lesions in the coronary arteries. In addition to increasing the risk of cardiovascular death and recurrent myocardial infarction, chronic angina has a significant impact on functional capacity and quality of life. All patients with cardiovascular disease should be closely questioned to determine the functional and symptomatic limitations attributable to ischemic symptoms. The Canadian Cardiovascular Society Classification of Angina is the easiest metric to use; however, more sensitive measures such as the Seattle Angina Questionnaire offer a better overall assessment of angina symptoms and quality of life and can be used to compare the efficacy of different treatments. Treatment strategies that begin with either immediate revascularization or optimal medical therapy with antianginal agents significantly improve angina frequency and quality of life. Initial revascularization, especially with coronary artery bypass grafting, appears to offer more rapid relief of angina compared with percutaneous coronary intervention or medical therapy in the first months after initial revascularization. After a year of follow-up, though, much of the treatment differences are lost and all strategies (surgical/percutaneous revascularization or medical therapy) result in a significant improvement of angina symptoms.

4 Clinical Trial Clopidogrel with or without omeprazole in coronary artery disease. 2010

Bhatt, Deepak L / Cryer, Byron L / Contant, Charles F / Cohen, Marc / Lanas, Angel / Schnitzer, Thomas J / Shook, Thomas L / Lapuerta, Pablo / Goldsmith, Mark A / Laine, Loren / Scirica, Benjamin M / Murphy, Sabina A / Cannon, Christopher P / Anonymous16400674. ·Veterans AffairsBoston Healthcare System, Brigham and Women's Hospital, Boston, MA 02132, USA. dlbhattmd@post.harvard.edu ·N Engl J Med · Pubmed #20925534.

ABSTRACT: BACKGROUND: Gastrointestinal complications are an important problem of antithrombotic therapy. Proton-pump inhibitors (PPIs) are believed to decrease the risk of such complications, though no randomized trial has proved this in patients receiving dual antiplatelet therapy. Recently, concerns have been raised about the potential for PPIs to blunt the efficacy of clopidogrel. METHODS: We randomly assigned patients with an indication for dual antiplatelet therapy to receive clopidogrel in combination with either omeprazole or placebo, in addition to aspirin. The primary gastrointestinal end point was a composite of overt or occult bleeding, symptomatic gastroduodenal ulcers or erosions, obstruction, or perforation. The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, revascularization, or stroke. The trial was terminated prematurely when the sponsor lost financing. RESULTS: We planned to enroll about 5000 patients; a total of 3873 were randomly assigned and 3761 were included in analyses. In all, 51 patients had a gastrointestinal event; the event rate was 1.1% with omeprazole and 2.9% with placebo at 180 days (hazard ratio with omeprazole, 0.34, 95% confidence interval [CI], 0.18 to 0.63; P<0.001). The rate of overt upper gastrointestinal bleeding was also reduced with omeprazole as compared with placebo (hazard ratio, 0.13; 95% CI, 0.03 to 0.56; P = 0.001). A total of 109 patients had a cardiovascular event, with event rates of 4.9% with omeprazole and 5.7% with placebo (hazard ratio with omeprazole, 0.99; 95% CI, 0.68 to 1.44; P = 0.96); high-risk subgroups did not show significant heterogeneity. The two groups did not differ significantly in the rate of serious adverse events, though the risk of diarrhea was increased with omeprazole. CONCLUSIONS: Among patients receiving aspirin and clopidogrel, prophylactic use of a PPI reduced the rate of upper gastrointestinal bleeding. There was no apparent cardiovascular interaction between clopidogrel and omeprazole, but our results do not rule out a clinically meaningful difference in cardiovascular events due to use of a PPI. (Funded by Cogentus Pharmaceuticals; ClinicalTrials.gov number, NCT00557921.).

5 Article Risk Assessment in Patients With Diabetes With the TIMI Risk Score for Atherothrombotic Disease. 2018

Bergmark, Brian A / Bhatt, Deepak L / Braunwald, Eugene / Morrow, David A / Steg, Ph Gabriel / Gurmu, Yared / Cahn, Avivit / Mosenzon, Ofri / Raz, Itamar / Bohula, Erin / Scirica, Benjamin M. ·Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. · French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France. · Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. · INSERM U-1148, Paris, France. · National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, U.K. · Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel. · Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA bscirica@bwh.harvard.edu. ·Diabetes Care · Pubmed #29196298.

ABSTRACT: OBJECTIVE: Improved risk assessment for patients with type 2 diabetes and elevated cardiovascular (CV) risk is needed. The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P) predicts a gradient of risk in patients with prior myocardial infarction (MI) but has not been evaluated in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: CV event rates were compared by baseline TRS 2°P in 16,488 patients enrolled in SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53) with type 2 diabetes and high CV risk or established CV disease. Calibration was tested in the diabetes cohort from the REACH (REduction of Atherothrombosis for Continued Health) Registry. RESULTS: TRS 2°P revealed a robust risk gradient for the composite of CV death, MI, and ischemic stroke in the full trial population, with 2-year event rates of 0.9% in the lowest- and 19.8% in the highest-risk groups ( CONCLUSIONS: The expanded TRS 2°P provides a practical and well-calibrated risk prediction tool for patients with type 2 diabetes.

6 Article Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. 2016

Eisen, Alon / Bhatt, Deepak L / Steg, P Gabriel / Eagle, Kim A / Goto, Shinya / Guo, Jianping / Smith, Sidney C / Ohman, E Magnus / Scirica, Benjamin M / Anonymous24340882. ·Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA. · Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM U-1148, Paris, France National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom. · University of Michigan Health System, Ann Arbor, MI. · Department of Medicine, Tokai University School of Medicine, Isehara, Japan. · Heart and Vascular Center, University of North Carolina at Chapel Hill, NC. · Duke University Medical Center, Durham, NC. · Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA bscirica@partners.org. ·J Am Heart Assoc · Pubmed #27680665.

ABSTRACT: BACKGROUND: The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated. METHODS AND RESULTS: Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end-point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11-1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99-1.14, P=0.11), and total primary end-point events (adjusted risk ratio 1.08, CI 1.01-1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06-1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21-1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13-1.34, P<0.001). CONCLUSIONS: Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

7 Article Universal Classification System Type of Incident Myocardial Infarction in Patients With Stable Atherosclerosis: Observations From Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P)-TIMI 50. 2016

Kidd, Stephen K / Bonaca, Marc P / Braunwald, Eugene / De Ferrari, Gaetano M / Lewis, Basil S / Merlini, Piera A / Murphy, Sabina A / Scirica, Benjamin M / White, Harvey D / Morrow, David A. ·Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Department of Molecular Medicine, University of Pavia, Italy Department of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy. · Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel. · IV Divisione Cardiologia, Azienda Ospedaliera Niguarda Ca' Granda, Milan, Italy. · TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Green Lane Cardiovascular Service, Auckland City Hospital, West Auckland, New Zealand. · TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA dmorrow@partners.org. ·J Am Heart Assoc · Pubmed #27431644.

ABSTRACT: BACKGROUND: Our dual aims were as follows: (1) to classify new or recurrent myocardial infarctions (MI) in patients with stable atherosclerosis using the Universal Definition of MI classification system; and (2) to characterize the effects of vorapaxar, a first-in-class platelet protease-activated receptor -1 antagonist, on new or recurrent MI. METHODS AND RESULTS: We analyzed data from TRA 2°P-TIMI 50, a multinational, randomized, double-blind, placebo-controlled trial of vorapaxar. This analysis included 20 770 patients with previous MI or peripheral arterial disease without a history of transient ischemic attack or stroke. Each new or recurrent MI after randomization that met the trial end point definition was further categorized according to the European Society of Cardiology, American College of Cardiology, American Heart Association, World Heart Federation Universal Definition classification of type and size. Of 1095 incident MIs, 77% were spontaneous (Type 1), with a smaller number (9.8%) of secondary MIs (Type 2). Vorapaxar reduced Type 1 MI (hazard ratio [HR] 0.84, CI 0.73-0.98, P=0.024), with a similar pattern for Type 2 MI (HR 0.74, CI 0.49-1.10, P=0.13). Notably, vorapaxar showed a consistent pattern of reduction across size of MIs, including MIs in the highest Universal MI size class (≥10× upper reference limit, HR 0.83, CI 0.70-0.98, P=0.025). As such, there was a significant reduction in larger, spontaneous MIs (Type 1, ≥10× upper reference limit, HR 0.81, CI 0.67-0.99, P=0.036), and a consistent pattern with respect to fatal MI (HR 0.66, CI 0.39-1.11, P=0.12). CONCLUSIONS: Among stable patients with established atherosclerosis, the most common type of incident MI is spontaneous MI, and the reduction in MI with vorapaxar was consistent across MIs of varying type and size, including spontaneous infarctions ≥10× upper reference limit. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00526474.

8 Article Outcomes According to Cardiac Catheterization Referral and Clopidogrel Use Among Medicare Patients With Non-ST-Segment Elevation Myocardial Infarction Discharged Without In-hospital Revascularization. 2016

Hess, Connie N / Hellkamp, Anne S / Roe, Matthew T / Thomas, Laine / Scirica, Benjamin M / Peng, S Andrew / Peterson, Eric D / Wang, Tracy Y. ·University of Colorado School of Medicine, Aurora, CO connie.hess@ucdenver.edu. · Duke Clinical Research Institute, Durham, NC. · Brigham and Women's Hospital, Boston, MA. ·J Am Heart Assoc · Pubmed #26976877.

ABSTRACT: BACKGROUND: While use of P2Y12 receptor inhibitor is recommended by guidelines, few studies have examined its effectiveness among older non-ST-segment elevation myocardial infarction patients who did not undergo coronary revascularization. METHODS AND RESULTS: We included unrevascularized non-ST-segment elevation myocardial infarction patients ≥65 years discharged home from 463 ACTION Registry-GWTG hospitals from 2007 to 2010. Rates of discharge clopidogrel use were described for patients with no angiography, angiography without obstructive coronary artery disease (CAD; ≥50% stenosis in ≥1 vessel), and angiography with obstructive CAD. Two-year outcomes were ascertained from linked Medicare data and included composite major adverse cardiac events (defined as all-cause death, myocardial infarction readmission, or revascularization), and individual components. Outcomes associated with clopidogrel use were adjusted using inverse probability-weighted propensity modeling. Of 14 154 unrevascularized patients, 54.7% (n=7745) did not undergo angiography, 10.6% (n=1494) had angiography without CAD, and 34.7% (n=4915) had angiography with CAD. Discharge clopidogrel was prescribed for 42.2% of all unrevascularized patients: 37.8% without angiography, 34.1% without obstructive CAD at angiography, and 51.6% with obstructive CAD at angiography. Discharge clopidogrel use was not associated with major adverse cardiac events in any group: without angiography (adjusted hazard ratio [95% CI]: 0.99 [0.93-1.06]), angiography without CAD (1.04 [0.74-1.47]), and angiography with CAD (1.12 [1.00-1.25], Pinteraction=0.20). CONCLUSIONS: We found no association between discharge clopidogrel use and long-term risk of major adverse cardiac events among older, unrevascularized non-ST-segment elevation myocardial infarction patients. Clopidogrel use in this population requires further prospective evaluation.

9 Article Incidence and predictors of incomplete revascularization in a contemporary cohort. 2016

Waldo, Stephen W / Abtahian, Farhad / Kennedy, Kevin F / Scirica, Benjamin M / Mahmood, Sadiqa / Yeh, Robert W. ·aDepartment of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado bDepartment of Medicine, Rochester General Hospital, Rochester, New York cSaint Luke's Mid-America Heart Institute, Kansas City, Missouri dDepartment of Medicine, Cardiovascular Division, Brigham and Women's Hospital eDepartment of Quality, Safety, and Value, Partners Healthcare fDepartment of Medicine, Division of Cardiology, Beth Israel Deaconess, Boston, Massachusetts, USA. ·Coron Artery Dis · Pubmed #26882019.

ABSTRACT: OBJECTIVES: Complete coronary revascularization has been associated with improved mortality among patients undergoing surgical bypass grafting. A similar evaluation among patients undergoing percutaneous coronary intervention (PCI) for multivessel disease has produced largely concordant results, although complete percutaneous revascularization is often not achieved in this population. The present study sought to evaluate the clinical and anatomic limitations to complete revascularization among contemporary patients undergoing percutaneous revascularization for multivessel coronary artery disease. METHODS: All patients undergoing nonemergent PCI for unprotected left main or multivessel coronary artery disease were identified at two academic medical centers from 2009 to 2012. Complete revascularization was determined through a review of the electronic medical records and corresponding coronary angiograms. The underlying reasons that precluded complete revascularization were then derived from a review of the clinical and angiographic findings. RESULTS: Among 978 patients with multivessel coronary artery disease, 267 (27%) underwent complete percutaneous coronary revascularization. Factors that prevented complete revascularization included chronic total occlusions (54%), treatment limited to the culprit lesion (24%), or persistent disease in small nondominant vessels (24%). After multivariable adjustment, the presence of a chronic total occlusion was associated with significantly reduced odds of receiving complete revascularization (adjusted odds ratio: 0.18, 95% confidence interval: 0.12-0.27). CONCLUSION: Complete percutaneous revascularization is uncommon and is hindered by the presence of chronic total occlusions or isolated treatment of an angiographic culprit lesion. Evolving interventional techniques enabling treatment of chronic total occlusions may increase the prevalence of complete percutaneous revascularization in the future.

10 Article Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. 2014

Waldo, Stephen W / Secemsky, Eric A / O'Brien, Cashel / Kennedy, Kevin F / Pomerantsev, Eugene / Sundt, Thoralf M / McNulty, Edward J / Scirica, Benjamin M / Yeh, Robert W. ·From the Department of Medicine, Division of Cardiology (S.W.W., E.A.S., C.O., E.P., R.W.Y.) and Division of Cardiac Surgery (T.M.S.), Massachusetts General Hospital, Boston · Saint Luke's Mid-America Heart Institute, Kansas City, MO (K.F.K.) · Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA (E.J.M.) · and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (B.M.S.). ·Circulation · Pubmed #25391519.

ABSTRACT: BACKGROUND: Decisions to proceed with surgical versus percutaneous revascularization for multivessel coronary artery disease are often based on subtle clinical information that may not be captured in contemporary registries. The present study sought to evaluate the association between surgical ineligibility documented in the medical record and long-term mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. METHODS AND RESULTS: All subjects undergoing nonemergent percutaneous coronary intervention for unprotected left main or multivessel coronary artery disease were identified at 2 academic medical centers from 2009 to 2012. Documentation of surgical ineligibility was assessed through review of electronic medical records. Cox proportional hazard models adjusted for known mortality risk factors were created to assess long-term mortality in patients with and without documentation of surgical ineligibility. Among 1013 subjects with multivessel coronary artery disease, 218 (22%) were deemed ineligible for coronary artery bypass graft surgery. The most common explicitly cited reasons for surgical ineligibility in the medical record were poor surgical targets (24%), advanced age (16%), and renal insufficiency (16%). After adjustment for known risk factors, documentation of surgical ineligibility remained independently associated with an increased risk of in-hospital (odds ratio, 6.26; 95% confidence interval, 2.16-18.15; P<0.001) and long-term mortality (hazard ratio, 2.98; 95% confidence interval, 1.88-4.72, P<0.001) after percutaneous coronary intervention. CONCLUSIONS: Documented surgical ineligibility is common and associated with significantly increased long-term mortality among patients undergoing percutaneous coronary intervention with unprotected left main or multivessel coronary disease, even after adjustment for known risk factors for adverse events during percutaneous revascularization.

11 Minor Response to Letter Regarding Article, "Surgical Ineligibility and Mortality Among Patients With Unprotected Left Main or Multivessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention". 2015

Waldo, Stephen W / Secemsky, Eric A / O'Brien, Cashel / Kennedy, Kevin F / Pomerantsev, Eugene / Sundt, Thoralf M / McNulty, Edward J / Scirica, Benjamin M / Yeh, Robert W. ·Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA. · Saint Luke's Mid-America Heart Institute, Kansas City, MO. · Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA. · Division of Cardiology, Kaiser Permanente Medical Center, San Francisco, CA. · Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA. ·Circulation · Pubmed #26391303.

ABSTRACT: -- No abstract --