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Coronary Artery Disease: HELP
Articles by Rajesh V. Swaminathan
Based on 14 articles published since 2010
(Why 14 articles?)
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Between 2010 and 2020, R. V. Swaminathan wrote the following 14 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 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.

3 Review Practical Considerations of Fractional Flow Reserve Utilization to Guide Revascularization. 2017

Shah, Tara / Geleris, Joshua D / Schulman-Marcus, Joshua / Feldman, Dmitriy N / Swaminathan, Rajesh V. ·Department of Medicine, Greenberg Division of Cardiology, New York Presbyterian Hospital-Weill Cornell Medicine, 520 East 70th Street, Starr-434 Pavilion, New York, NY, 10021, USA. tas2012@nyp.org. · Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA. · Division of Cardiology, Albany Medical Center, 47 New Scotland Ave, MC-44, Albany, NY, 12208, USA. · Department of Medicine, Greenberg Division of Cardiology, New York Presbyterian Hospital-Weill Cornell Medicine, 520 East 70th Street, Starr-434 Pavilion, New York, NY, 10021, USA. · Duke Clinical Research Institute, Duke University Medical Center, 508 Fulton Street (A3014), Durham, NC, 27705, USA. ·Curr Treat Options Cardiovasc Med · Pubmed #28281238.

ABSTRACT: OPINION STATEMENT: Invasive angiography has long been the gold standard for the diagnosis of obstructive coronary artery disease (CAD). However, the relationship between angiographic measures of stenosis and coronary blood flow is complex, and there is frequent discordance between the visual assessment of a stenotic lesion and its effect on myocardial perfusion. Fractional flow reserve is a rapidly emerging invasive means of assessing the physiologic significance of an epicardial stenosis. This review provides a pragmatic understanding of the physiologic principles that guide fractional flow reserve (FFR), sheds light on its nuances, and explores the most landmark investigations. We will also discuss how the measurement of FFR can be helpful or limiting in several common clinical situations.

4 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.

5 Article Testing for Coronary Artery Disease in Older Patients With New-Onset Heart Failure: Findings From Get With The Guidelines-Heart Failure. 2020

O'Connor, Kyle D / Brophy, Todd / Fonarow, Gregg C / Blankstein, Ron / Swaminathan, Rajesh V / Xu, Haolin / Matsouaka, Roland A / Albert, Nancy M / Velazquez, Eric J / Yancy, Clyde W / Heidenreich, Paul A / Hernandez, Adrian F / DeVore, Adam D. ·Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (K.D.O., R.V.S., H.X., R.A.M., A.F.H., A.D.D.). · Department of Cardiovascular Medicine (T.B.). · Heart and Vascular Institute, Cleveland Clinic, OH. Division of Cardiology, University of California, Los Angeles (G.C.F.). · Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (R.B.). · Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.). · Nursing Institute, Office of Nursing Research and Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH (N.M.A.). · Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, CT (E.J.V.). · Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL (C.W.Y.). · Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (P.A.H.). · Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA (P.A.H.). ·Circ Heart Fail · Pubmed #32207996.

ABSTRACT: BACKGROUND: Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF. METHODS: We performed an observational cohort study using the Get With The Guidelines-Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization. RESULTS: Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%-49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all CONCLUSIONS: The majority of patients hospitalized for new-onset HF did not receive testing for CAD either during the hospitalization or in the 90 days before and after. The rates of testing for CAD were higher in patients with LVEF ≤40% though remained low. These data highlight an opportunity to improve care by identifying appropriate candidates for optimal CAD medical therapy and revascularization.

6 Article Risk of obstructive coronary artery disease and major adverse cardiac events in patients with noncoronary atherosclerosis: Insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program. 2019

Gutierrez, J Antonio / Bhatt, Deepak L / Banerjee, Subhash / Glorioso, Thomas J / Josey, Kevin P / Swaminathan, Rajesh V / Maddox, Thomas M / Armstrong, Ehrin J / Duvernoy, Claire / Waldo, Stephen W / Rao, Sunil V. ·Durham VA Medical Center, Duke Clinical Research Institute, Duke University, School of Medicine, Durham, NC. Electronic address: antonio.gutierrez@duke.edu. · Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA. · Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX. · VA Eastern Colorado Healthcare System, Denver, CO. · Durham VA Medical Center, Duke Clinical Research Institute, Duke University, School of Medicine, Durham, NC. · Cardiology Division, Washington University School of Medicine, St Louis, MO. · VA Ann Arbor Healthcare System, University of Michigan Health System, Ann Arbor, MI. ·Am Heart J · Pubmed #31102799.

ABSTRACT: We sought to determine the risk of obstructive coronary artery disease (oCAD) associated with noncoronary atherosclerosis (cerebrovascular disease [CVD] or peripheral arterial disease [PAD]) and major adverse cardiac events following percutaneous coronary intervention (PCI). METHODS: Rates of the angiographic end point of oCAD were compared among patients with and without noncoronary atherosclerosis undergoing coronary angiography within the Veterans Health Administration between October 2007 and August 2015. The primary angiographic end point of oCAD was defined as left main stenosis ≥50% or any stenosis ≥70% in 1, 2, or 3 vessels. In patients who proceeded to PCI, the rate of the composite clinical end point of death, myocardial infarction, or stroke was compared among those with concomitant noncoronary atherosclerosis (CVD, PAD, or CVD + PAD) versus isolated CAD. RESULTS: Among 233,353 patients undergoing angiography, 9.6% had CVD, 12.4% had PAD, and 6.1% had CVD + PAD. Rates of oCAD were 57.9% for neither CVD nor PAD, 66.4% for CVD, 73.6% for PAD, and 80.9% for CVD + PAD. Compared with patients without noncoronary atherosclerosis, the adjusted risk of oCAD with CVD, PAD, or CVD + PAD was 1.03 (95% CI 1.02-1.04), 1.10 (95% CI 1.09-1.11), and 1.12 (95% CI 1.11-1.13), respectively. In patients who underwent PCI, the adjusted hazard for death, myocardial infarction, or stroke among those with CVD, PAD, or CVD + PAD was 1.36 (95% CI 1.26-1.45), 1.53 (95% CI 1.45-1.62), and 1.72 (95% CI 1.59-1.86), respectively. CONCLUSIONS: In patients undergoing coronary angiography, noncoronary atherosclerosis was associated with increased burden of oCAD and adverse events post-PCI.

7 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.

8 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.

9 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.

10 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.

11 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.

12 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.

13 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.

14 Unspecified Robotic-assisted transradial diagnostic coronary angiography. 2018

Swaminathan, Rajesh V / Rao, Sunil V. ·Durham VA Medical Center, 508 Fulton Street, Durham, North Carolina, 27705. ·Catheter Cardiovasc Interv · Pubmed #29314560.

ABSTRACT: Robotic percutaneous coronary interventions have recently been introduced in the cardiac catheterization laboratory. Robotics offers benefits of greater precision for stent placement and occupational hazard protection for operators and staff. First generation systems were able to advance and retract coronary wires, balloons, and stents, but did not have guide control functions. The second-generation robotic system (CorPath GRX) has an active guide management function offering the ability to move guide catheters. Expanding utilization of robotics to perform diagnostic coronary angiography would further reduce radiation scatter exposure and other occupational hazards to operators. This approach is particularly appealing in the setting of radial access, as universal radial diagnostic catheters can engage both the right and left coronary arteries without exchange. We describe here, the first two cases of such a procedure with the CorPath GRX robotic system.