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Coronary Artery Disease: HELP
Articles by Rajesh V. Swaminathan
Based on 10 articles published since 2008
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Between 2008 and 2019, R. V. Swaminathan wrote the following 10 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
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 Review Innovations in drug-eluting stents. 2013

Nallu, K / Yang, D C / Swaminathan, R V / Kim, L K / Feldman, D. ·Division of Cardiology, Weill Cornell Medical College New York Presbyterian Hospital New York, New York, USA - dnf9001@med.cornell.edu. ·Panminerva Med · Pubmed #24434343.

ABSTRACT: Coronary artery disease affects patients worldwide and is a major cause of morbidity and mortality. Historically, the treatment approach for patients with coronary syndromes has been surgical. In the 1970s, percutaneous balloon angioplasty was introduced, leading to creation of a new field of interventional cardiology, which allowed a non-surgical minimally invasive approach to treat patients with coronary artery disease. However, the major limitations of balloon angioplasty were acute vessel closure and later restenosis. The introduction of bare metal stents and then drug-eluting stents (DES) revolutionized the practice of interventional cardiology and allowed for safe treatment of increasingly complex coronary artery lesions. Although drug-eluting coronary stents improve patient outcomes, they still have limitations. These limitations may arise from delayed endothelialization, local vessel hypersensitivity and endothelial dysfunction secondary to the drug elution, the durable polymer coating, or the stent scaffold. This comprehensive review will discuss the evolution of intracoronary stents from their introduction to current utilization of DES as well as future research on bioabsorbable stents and polymers.

3 Article Comparison of Trends and In-Hospital Outcomes of Concurrent Carotid Artery Revascularization and Coronary Artery Bypass Graft Surgery: The United States Experience 2004 to 2012. 2017

Feldman, Dmitriy N / Swaminathan, Rajesh V / Geleris, Joshua D / Okin, Peter / Minutello, Robert M / Krishnan, Udhay / McCormick, Daniel J / Bergman, Geoffrey / Singh, Harsimran / Wong, S Chiu / Kim, Luke K. ·Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. Electronic address: dnf9001@med.cornell.edu. · Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina. · Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. · Department of Cardiovascular Medicine, Pennsylvania Hospital-University of Pennsylvania Health System, Philadelphia, Pennsylvania. ·JACC Cardiovasc Interv · Pubmed #28183469.

ABSTRACT: OBJECTIVES: The aim of this study was to compare trends and outcomes of 3 approaches to carotid revascularization in the coronary artery bypass graft (CABG) population when performed during the same hospitalization. BACKGROUND: The optimal approach to managing coexisting severe carotid and coronary disease remains controversial. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are used to decrease the risk of stroke in patients with carotid disease undergoing CABG surgery. METHODS: The authors conducted a serial, cross-sectional study with time trends of 3 revascularization groups during the same hospital admission: 1) combined CEA+CABG; 2) staged CEA+CABG; and 3) staged CAS+CABG from the Nationwide Inpatient Sample database 2004 to 2012. The primary composite endpoints were in-hospital all-cause death, stroke, and death/stroke. RESULTS: During the 9-year period, 22,501 concurrent carotid revascularizations and CABG surgeries during the same hospitalization were performed. Of these, 15,402 (68.4%) underwent combined CEA+CABG, 6,297 (28.0%) underwent staged CEA+CABG, and 802 (3.6%) underwent staged CAS+CABG. The overall rate of CEA+CABG decreased by 16.1% (p CONCLUSIONS: In patients with concomitant carotid and coronary disease undergoing combined revascularization, combined CEA+CABG is utilized most frequently, followed by staged CEA+CABG and staged CAS+CABG strategies. The staged CAS+CABG strategy was associated with lower risk of mortality, but higher risk of stroke. Future studies are needed to examine the risks/benefits of different carotid revascularization strategies for high-risk patients requiring concurrent CABG.

4 Article Five-year mortality outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention. 2017

Patel, Agam D / Ibrahim, Mohammed / Swaminathan, Rajesh V / Minhas, Irfan U / Kim, Luke K / Venkatesh, Prashanth / Feldman, Dmitriy N / Minutello, Robert M / Bergman, Geoffrey W / Wong, S Chiu / Singh, Harsimran S. ·Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York. ·Catheter Cardiovasc Interv · Pubmed #27519355.

ABSTRACT: OBJECTIVE: To examine peri-procedural and long-term outcomes in patients with chronic kidney disease (CKD) undergoing percutaneous coronary interventions (PCI). BACKGROUND: Patients with advanced CKD are considered high risk when undergoing PCI. Limited published data exist on quantifying risk and assessment of long-term outcomes after PCI in this group. METHODS: Examining the Cornell Coronary Registry, we prospectively collected data of 6,478 consecutive patients who underwent elective or urgent PCI between 2009 and 2013. Patients were grouped into CKD stages by estimated glomerular filtration rate (eGFR) according to KDOQI guidelines. Procedural and 30-day outcomes are reported with assessment of long-term differences in 5-year all-cause mortality. RESULTS: Patients were grouped by CKD stages: 1,351 patients with eGFR ≥90 mL/min/1.73 m CONCLUSION: Among patients undergoing PCI, lower GFR is associated with decreased long-term survival. © 2016 Wiley Periodicals, Inc.

5 Article Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting. 2016

Swaminathan, Rajesh V / Feldman, Dmitriy N / Pashun, Raymond A / Patil, Rupa K / Shah, Tara / Geleris, Joshua D / Wong, Shing-Chiu / Girardi, Leonard N / Gaudino, Mario / Minutello, Robert M / Singh, Harsimran S / Bergman, Geoffrey / Kim, Luke K. ·Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. Electronic address: rvs9001@med.cornell.edu. · Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York; Department of Cardiovascular Sciences, Catholic University, Rome, Italy. ·Am J Cardiol · Pubmed #27269585.

ABSTRACT: Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012. We included all patients who underwent isolated CABG surgery (n = 2,272,998; female n = 623,423 [27.4%]; male n = 1,649,575 [72.6%]). The annual rate of CABG surgeries decreased by 53.7% in men and 57.8% in women over the 10-year study period. Although internal mammary artery use in women was less frequent than in men in 2003 (77.4% vs 81.9%, p <0.001), a significant uptrend closed this gap by 2012 (86.2% vs 87.0%, ptrend 0.003). Overall, unadjusted in-hospital mortality was greater in women (3.2% vs 1.8%, p <0.001). Female gender remained an independent predictor of mortality after multivariate adjustment (odds ratio 1.40, 95% CI 1.36 to 1.43, p <0.001) across all age groups. However, in-hospital mortality decreased at a faster rate in women (3.8% to 2.7%, RR -29.1%, ptrend 0.002) than in men (2.2% to 1.6%, RR -25.7%, ptrend <0.001) from 2003 to 2012. In conclusion, CABG rates in the United States are decreasing over time, yet in-hospital mortality continues to improve. Women have worse in-hospital outcomes than men; however, the gender gap is slowly closing.

6 Article Characteristics of Patients Undergoing Cardiac Catheterization Before Noncardiac Surgery: A Report From the National Cardiovascular Data Registry CathPCI Registry. 2016

Schulman-Marcus, Joshua / Feldman, Dmitriy N / Rao, Sunil V / Prasad, Abhiram / McCoy, Lisa / Garratt, Kirk / Kim, Luke K / Minutello, Robert M / Wong, Shing-Chiu / Vora, Amit N / Singh, Harsimran S / Wojdyla, Daniel / Mohsen, Amr / Bergman, Geoffrey / Swaminathan, Rajesh V. ·Department of Medicine, Weill Cornell Medical College, New York, New York. · Greenberg Division of Cardiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York. · Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. · Cardiac Research Centre, St George's Hospital, London, United Kingdom. · Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware. · William Beaumont Health System, Royal Oak, Michigan. ·JAMA Intern Med · Pubmed #27018942.

ABSTRACT: IMPORTANCE: Many patients undergo cardiac catheterization and/or percutaneous coronary intervention (PCI) before noncardiac surgery even though these procedures are not routinely indicated. Data on this cohort of patients are limited. OBJECTIVE: To describe the characteristics, angiographic findings, and treatment patterns of clinically stable patients undergoing cardiac catheterization and/or PCI before noncardiac surgery in a large national registry. DESIGN, SETTING, AND PARTICIPANTS: This study is a retrospective, descriptive analysis of National Cardiac Data Registry CathPCI Registry diagnostic catheterization and PCI data from July 1, 2009, through December 31, 2014. Data analysis was performed from April 21, 2015, to January 4, 2016. The study included 194 444 patients from 1046 sites who underwent coronary angiography before noncardiac surgery. Patients with acute coronary syndrome, cardiogenic shock, cardiac arrest, or emergency catheterization were excluded. MAIN OUTCOMES AND MEASURES: Demographic characteristics, preprocedure noninvasive testing results, angiographic findings, and treatment recommendations are summarized. Among the 27 838 patients who underwent PCI, procedural details, inpatient outcomes, and discharge medications are reported. RESULTS: Of the 194 444 included patients, 113 590 (58.4%) were male, the median age was 65 years (interquartile range, 57-73 years), and 162 532 (83.6%) were white. Most were overweight or obese (152 849 [78.6%]), and 78 847 (40.6%) had diabetes mellitus. Most patients were asymptomatic (117 821 [60.6%]), although 112 302 (57.8%) had been taking antianginal medications within 2 weeks of the procedure. Prior noninvasive stress testing was reported in 126 766 (65.2%), and results were positive in 109 458 (86.3%) of those with stress data. Obstructive disease was present in 93 447 (48.1%). After diagnostic angiography, revascularization with PCI or bypass surgery was recommended in 46 380 patients (23.8%) in the overall cohort, 27 191 asymptomatic patients (23.1%), and 45 083 patients with obstructive disease (48.3%). In the 27 191 patients undergoing PCI, 367 treated lesions (1.3%) were in the left main artery and 3831 (13.8%) in the proximal left anterior descending artery. A total of 11 366 patients (40.8%) received drug-eluting stents. Complications occurred in a few patients, with a catheterization-related mortality rate of 0.05%. CONCLUSIONS AND RELEVANCE: In the largest contemporary US cohort reported to date, most patients undergoing diagnostic catheterization before noncardiac surgery are asymptomatic. The discovery of obstructive coronary artery disease is common, and although randomized clinical trials have found no benefit in outcomes, revascularization is recommended in nearly half of these patients. The overall findings highlight management patterns in this population and the need for greater evidence-based guidelines and practices.

7 Article Outcomes in patients undergoing coronary artery bypass graft surgery in the United States based on hospital volume, 2007 to 2011. 2016

Kim, Luke K / Looser, Patrick / Swaminathan, Rajesh V / Minutello, Robert M / Wong, S Chiu / Girardi, Leonard / Feldman, Dmitriy N. ·Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY. Electronic address: luk9003@med.cornell.edu. · Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY. ·J Thorac Cardiovasc Surg · Pubmed #26964912.

ABSTRACT: OBJECTIVE: To examine national trends in coronary artery bypass grafting (CABG) volume between 2007 and 2011, and analyze in-hospital outcomes after CABG surgery stratified according to hospital volume. METHODS: We analyzed all patients who underwent isolated CABG surgery between 2007 and 2011 in the National Inpatient Sample database. Trends in procedure volume and rates of adverse in-hospital outcomes were examined. Multivariate propensity-score adjusted analysis was performed to compare in-hospital mortality for hospitals based on quartiles of CABG volume. RESULTS: The frequency of isolated CABG decreased by 25.4% from 2007 to 2011 (from 326 cases per million adults to 243 cases per million adults), with the most marked decline at higher-volume centers. Patients in the highest-volume quartile were more likely to have a history of previous CABG, previous percutaneous coronary intervention, peripheral vascular disease, hypertension, or chronic renal failure. In-hospital mortality was highest in low-volume centers. In multivariate logistic regression analysis, low hospital volume was an independent predictor of in-hospital all-cause mortality (adjusted odds ratio, 1.39; 95% confidence interval, 1.24-1.56; P < .001). CONCLUSIONS: The rate of CABG procedures has declined, mainly at high-volume centers. Low CABG volume is associated with an increase in in-hospital mortality.

8 Article Rate of percutaneous coronary intervention for the management of acute coronary syndromes and stable coronary artery disease in the United States (2007 to 2011). 2014

Kim, Luke K / Feldman, Dmitriy N / Swaminathan, Rajesh V / Minutello, Robert M / Chanin, Jake / Yang, David C / Lee, Min Kyeong / Charitakis, Konstantinos / Shah, Ashish / Kaple, Ryan K / Bergman, Geoffrey / Singh, Harsimran / Wong, S Chiu. ·Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. Electronic address: luk9003@med.cornell.edu. · Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York. · Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Massachusetts. ·Am J Cardiol · Pubmed #25118124.

ABSTRACT: Although the benefit of percutaneous coronary interventions (PCIs) for patients presenting with acute coronary syndromes (ACS) has been established in numerous studies, the role of PCI in stable coronary artery disease (CAD) remains controversial. With the publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluations trial and the appropriate use criteria for coronary artery revascularization, we sought to examine the impact of these treatment strategies and guidelines on the current practice of PCI in United States. We conducted a serial cross-sectional study with time trends of patients undergoing PCI for ACS and stable CAD from 2007 to 2011. The annual rate of all PCI decreased by 27.7% from 10,785 procedures per million adults per year in 2007 to 2008 to 7,801 procedures per million adults per year in 2010 to 2011 (p=0.03). Although there was no statistically significant decrease in the PCI utilization for ACS from 2007 to 2011, PCI utilization for stable CAD decreased by 51.7% (from 2,056 procedures per million adults per year in 2008 to 992 procedures per million adults per year in 2011, p=0.02). Hospitals with a higher volume of PCI experienced a more significant decrease. Decrease in PCI utilization for stable CAD was statistically significant for patients with Medicare and private insurance/health maintenance organization (44.5%, p=0.03 and 59.5%, p=0.007, respectively). In conclusion, the rate of PCI decreased substantially starting from 2009 in the United States. Most of the decrease was attributed to the reduction in PCI utilization for stable CAD.

9 Article Impact of long-term statin therapy on postprocedural myocardial infarction in patients undergoing nonemergency percutaneous coronary intervention. 2012

Gordin, Jonathan / Haider, Ali / Swaminathan, Rajesh V / Kim, Luke K / Minutello, Robert M / Bergman, Geoffrey / Wong, S Chiu / Feldman, Dmitriy N. ·Greenberg Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA. ·Am J Cardiol · Pubmed #22858186.

ABSTRACT: Periprocedural statin therapy has been shown to decrease the rate of myocardial infarctions (MIs) after percutaneous coronary intervention (PCI). However, the impact of long-term statin therapy on postprocedure MI remains unknown. We examined the impact of long-term statin therapy on cardiac enzyme (cardiac troponin I [cTnI] and creatine kinase-MB [CK-MB]) increases after PCI in patients undergoing nonemergency PCI. Using the 2004/2005 Cornell Angioplasty Registry, we evaluated 1,482 patients undergoing elective or urgent PCI with normal preprocedure cardiac enzymes levels (cTnI and CK-MB). The population was divided into 2 groups: (1) patients on long-term (≥7 days) statin therapy before PCI (n = 1,073) and (2) patients not on long-term statin regimen (n = 409). Cardiac enzyme levels after PCI were assessed at 8, 12, and 18 hours after PCI. An increase in cTnI ≥1 time upper-limit of normal (ULN) was observed in 830 patients (56.1%) and an increase in cTnI ≥3 times ULN was observed in 518 patients (35.0%). There was no difference in incidence of cTnI increases ≥3 times ULN in patients on long-term statin therapy versus those not on long-term statin therapy in the overall group (35.1% vs 34.5%, p = 0.855). There was a trend toward a lower incidence of small cTnI increases ≥1 time ULN in patients on long-term statin therapy versus those not receiving long-term statins (54.6% vs 59.7%, p = 0.090). Incidence of CK-MB increases ≥1 time or ≥3 times ULN and peak cTnI and CK-MB levels were similar between the 2 groups. In a subgroup of patients with unstable angina, long-term statin therapy decreased small cTnI increases (≥1 time ULN) after PCI (54.6% vs 64.3%, p = 0.023). The greatest benefit in decrease of MIs after PCI was seen in patients with unstable angina receiving long-term high-dose statin therapy. In conclusion, long-term statin therapy did not decrease the incidence of periprocedural MI in patients with stable coronary artery disease undergoing nonemergency PCI. In patients with unstable coronary syndromes, long-term statin therapy may be beneficial, particularly at a high dose.

10 Article High-definition multidetector computed tomography for evaluation of coronary artery stents: comparison to standard-definition 64-detector row computed tomography. 2009

Min, James K / Swaminathan, Rajesh V / Vass, Melissa / Gallagher, Scott / Weinsaft, Jonathan W. ·The Greenberg Division of Cardiology, Weill Medical College of Cornell University, The New York Presbyterian Hospital, 520 E 70th Street, K415, New York, NY 10021, USA. jkm2001@med.cornell.edu ·J Cardiovasc Comput Tomogr · Pubmed #19577213.

ABSTRACT: BACKGROUND: The assessment of coronary stents with present-generation 64-detector row computed tomography scanners that use filtered backprojection and operating at standard definition of 0.5-0.75 mm (standard definition, SDCT) is limited by imaging artifacts and noise. OBJECTIVES: We evaluated the performance of a novel, high-definition 64-slice CT scanner (HDCT), with improved spatial resolution (0.23 mm) and applied statistical iterative reconstruction (ASIR) for evaluation of coronary artery stents. METHODS: HDCT and SDCT stent imaging was performed with the use of an ex vivo phantom. HDCT was compared with SDCT with both smooth and sharp kernels for stent intraluminal diameter, intraluminal area, and image noise. Intrastent visualization was assessed with an ASIR algorithm on HDCT scans, compared with the filtered backprojection algorithms by SDCT. RESULTS: Six coronary stents (2.5, 2.5, 2.75, 3.0, 3.5, 4.0mm) were analyzed by 2 independent readers. Interobserver correlation was high for both HDCT and SDCT. HDCT yielded substantially larger luminal area visualization compared with SDCT, both for smooth (29.4+/-14.5 versus 20.1+/-13.0; P<0.001) and sharp (32.0+/-15.2 versus 25.5+/-12.0; P<0.001) kernels. Stent diameter was higher with HDCT compared with SDCT, for both smooth (1.54+/-0.59 versus1.00+/-0.50; P<0.0001) and detailed (1.47+/-0.65 versus 1.08+/-0.54; P<0.0001) kernels. With detailed kernels, HDCT scans that used algorithms showed a trend toward decreased image noise compared with SDCT-filtered backprojection algorithms. CONCLUSIONS: On the basis of this ex vivo study, HDCT provides superior detection of intrastent luminal area and diameter visualization, compared with SDCT. ASIR image reconstruction techniques for HDCT scans enhance the in-stent assessment while decreasing image noise.