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Coronary Artery Disease: HELP
Articles by William S. Weintraub
Based on 39 articles published since 2010
(Why 39 articles?)
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Between 2010 and 2020, William Weintraub wrote the following 39 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. 2012

Anonymous810721 / Patel, Manesh R / Dehmer, Gregory J / Hirshfeld, John W / Smith, Peter K / Spertus, John A / Anonymous820721 / Masoudi, Frederick A / Dehmer, Gregory J / Patel, Manesh R / Smith, Peter K / Chambers, Charles E / Ferguson, T Bruce / Garcia, Mario J / Grover, Frederick L / Holmes, David R / Klein, Lloyd W / Limacher, Marian C / Mack, Michael J / Malenka, David J / Park, Myung H / Ragosta, Michael / Ritchie, James L / Rose, Geoffrey A / Rosenberg, Alan B / Russo, Andrea M / Shemin, Richard J / Weintraub, William S / Anonymous830721 / Wolk, Michael J / Bailey, Steven R / Douglas, Pamela S / Hendel, Robert C / Kramer, Christopher M / Min, James K / Patel, Manesh R / Shaw, Leslee / Stainback, Raymond F / Allen, Joseph M / Anonymous840721 / Anonymous850721 / Anonymous860721 / Anonymous870721 / Anonymous880721 / Anonymous890721 / Anonymous900721 / Anonymous910721. · ·J Thorac Cardiovasc Surg · Pubmed #22424518.

ABSTRACT: The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research.

2 Editorial Cost-Effectiveness and Economic Burden of PCI. 2018

Iantorno, Micaela / Weintraub, William S. ·Section of Interventional Cardiology, MedStar Heart & Vascular Institute, Georgetown University, Washington, DC. · Section of Interventional Cardiology, MedStar Heart & Vascular Institute, Georgetown University, Washington, DC. Electronic address: William.s.weintraub@medstar.net. ·Cardiovasc Revasc Med · Pubmed #30146118.

ABSTRACT: -- No abstract --

3 Editorial Multivessel coronary artery disease and poor left ventricle function: It is consistent and clear, coronary artery bypass grafting wins again. 2018

Attaran, Saina / Weintraub, William S / Thourani, Vinod H. ·Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC. · Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC. Electronic address: vinod.h.thourani@medstar.net. ·J Thorac Cardiovasc Surg · Pubmed #29910104.

ABSTRACT: -- No abstract --

4 Editorial Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management. 2017

Schulman-Marcus, Joshua / Weintraub, William S / Boden, William E. ·Division of Cardiology, Albany Medical Center, Albany Medical College,Albany, New York. Electronic address: schulmj1@mail.amc.edu. · Division of Cardiology, Christiana Healthcare System,Newark, Delaware. · VA New England Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center (MAVERIC), Boston University School of Medicine,Boston, Massachusetts. ·Am J Cardiol · Pubmed #28818317.

ABSTRACT: Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making.

5 Editorial Coronary Revascularization in the Current Era. 2015

Weiss, Sandra / Weintraub, William. ·Christiana Care Health System, Newark, DE, USA. Electronic address: SWeiss@christianacare.org. · Christiana Care Health System, Newark, DE, USA. ·Prog Cardiovasc Dis · Pubmed #26471932.

ABSTRACT: -- No abstract --

6 Review Risk of mortality with paclitaxel drug-coated balloon in de novo coronary artery disease. 2020

Yerasi, Charan / Case, Brian C / Forrestal, Brian J / Kolm, Paul / Dan, Kazuhiro / Torguson, Rebecca / Weintraub, William S / Garcia-Garcia, Hector M / Waksman, Ron. ·Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, United States of America. · Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington, DC, United States of America. Electronic address: ron.waksman@medstar.net. ·Cardiovasc Revasc Med · Pubmed #32317227.

ABSTRACT: A recent meta-analysis showed increased mortality with paclitaxel drug-coated balloons (PCB) in peripheral arterial disease. With the absence of a definitive study evaluating the risk of mortality with PCB in de novo coronary artery disease, we performed a systematic review and critical appraisal of the literature analyzing this risk. In this review, we included 17 trials with a total of 1573 patients. Cardiac mortality was reported in 16 studies and all-cause mortality in 14 studies. Eleven studies had <12 months' follow-up; 6 had ≥12 months' follow-up. None of the studies was powered to evaluate any differences in mortality. The majority of the included studies have a Jadad scale ≤2. Ten of 17 studies had no mortality, 4 had numerically higher mortality with PCB, and 3 had lower or same mortality with PCB, when compared to drug-eluting stents. A standard meta-analysis cannot be performed, as most studies did not report hazard ratios or Kaplan-Meier survival plots on mortality. With the available literature, conclusions cannot be made in identifying the association of mortality with PCB in de novo coronary artery disease. There is an urgent need for well-designed studies with long-term follow-up for PCB in de novo coronary artery disease. A recent meta-analysis showed increased mortality with paclitaxel drug-coated balloon (PCB) in peripheries. No studies to date evaluate the risk of mortality with PCB in de novo coronary artery disease. In this systematic review and critical appraisal of literature, we outline why the risk cannot be elucidated from the available literature. A standard meta-analysis using inverse variance method would be incorrect to use, as mortality is a time-to-event data point, and only 1 out of 17 studies reported a Kaplan-Meier survival plot.

7 Review Drug-Coated Balloon for De Novo Coronary Artery Disease: JACC State-of-the-Art Review. 2020

Yerasi, Charan / Case, Brian C / Forrestal, Brian J / Torguson, Rebecca / Weintraub, William S / Garcia-Garcia, Hector M / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net. ·J Am Coll Cardiol · Pubmed #32138967.

ABSTRACT: Percutaneous coronary intervention with a drug-eluting stent is the most common mode of revascularization for coronary artery disease. However, restenosis rates remain high. Non-stent-based local drug delivery by a drug-coated balloon (DCB) has been investigated, as it leaves no metallic mesh. A DCB consists of a semicompliant balloon coated with antiproliferative agents encapsulated in a polymer matrix, which is released into the wall after inflation and contact with the intima. DCB have demonstrated effectiveness in treating in-stent restenosis. Clinical studies using DCB in de novo coronary artery disease have shown mixed results, with a major benefit in small-vessel disease. Differences in study results are not only due to variations in DCB technology but also to disparity in procedural approach, "leave nothing behind" or "combination therapy," and vessel size. This review focuses on the available evidence from randomized trials and proposes a design for future clinical trials.

8 Review Genetic and Nongenetic Implications of Racial Variation in Response to Antiplatelet Therapy. 2019

Iantorno, Micaela / Weintraub, William S / Garcia-Garcia, Hector M / Attaran, Saina / Gajanana, Deepakraj / Buchanan, Kyle D / Rogers, Toby / Torguson, Rebecca / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net. ·Am J Cardiol · Pubmed #30967284.

ABSTRACT: Race has been identified as an independent risk factor for poor prognosis and an independent predictor of survival in coronary artery disease. Race-related dissimilarities have been identified in cardiovascular patients in terms of age of presentation, co-morbidities, socioeconomic status, and treatment approach as well as genetically driven race-related disparities in responsiveness to medications. Antiplatelet therapy represents a fundamental component of therapy in cardiovascular patients, especially in patients presenting with acute coronary syndromes. It has been argued that the different level of platelet reactivity and varying response to antiplatelet therapy among races may account in part for worse outcomes in certain populations. The purpose of this review is to describe genotypic and phenotypic race-related differences in platelet reactivity and responsiveness to cardiovascular treatment, focusing on antiplatelet therapy to highlight the need establish a more effective and targeted antithrombotic strategy.

9 Review Historical Milestones in the Management of Stable Coronary Artery Disease over the Last Half Century. 2018

Weintraub, William S / Taggart, David P / Mancini, G B John / Brown, David L / Boden, William E. ·MedStar Heart and Vascular Institute, Georgetown University, Washington, DC. Electronic address: wswdelaware@gmail.com. · Oxford University, United Kingdom. · Division of Cardiology, University of British Columbia, Vancouver. · Division of Cardiovascular Medicine, Washington University School of Medicine, St. Louis, Mo. · VA New England Healthcare System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, and Boston University School of Medicine, Boston. ·Am J Med · Pubmed #29959899.

ABSTRACT: Coronary revascularization for coronary artery disease dates back to the introduction of coronary bypass by Favaloro in 1967 and coronary angioplasty by Gruentzig in 1977 (first published in 1968 and 1978, respectively). There have been many technical improvements over the ensuing 5 decades, studied in clinical trials. This article reviews the history of coronary revascularization (the development of optimal medical therapy) and points the way to the future of stable coronary artery disease management.

10 Review A narrative overview: Have clinical trials of PCI vs medical therapy addressed the right question? 2018

Morrone, Doralisa / Marzilli, Mario / Panico, Roberta Antonazzo / Kolm, Paul / Weintraub, William S. ·Christiana Care Health System, Newark, DE, USA; Surgery Pathology, Medical, Molecular and Critic Area Department-Cardiovascular Disease Section, Pisa University, Italy. Electronic address: doralisa.morrone@unipi.it. · Surgery Pathology, Medical, Molecular and Critic Area Department-Cardiovascular Disease Section, Pisa University, Italy. · Christiana Care Health System, Newark, DE, USA. ·Int J Cardiol · Pubmed #29957261.

ABSTRACT: BACKGROUND: In RCTs about revascularization, the terms "coronary artery disease" and "ischemic heart disease" are sometimes used interchangeably. This can create confusion concerning inclusion and exclusion criteria, which may lead to uncertain results. OBJECTIVE: Our purpose is to investigate whether the study populations in randomized controlled trials (RCTs) which compared percutaneous coronary revascularization to medical therapy for stable ischemic heart disease specifically enrolled patients with demonstrable ischemia, and how many patients were included in trials with evidence of coronary atherosclerosis but without evidence of ischemia. METHODS: Trial published data were obtained from ACME I, ACME II, RITA I, RITA II, MASS I, MASS II, AVERT, ACIP, COURAGE and FAME2. Published data were used to calculate the number of patients included in the trials with a negative stress test but significant coronary artery stenosis and the number of patients excluded from the trials with a positive stress test or angina, but without significant coronary artery stenosis at the time of angiography. RESULTS: A total of 196,433 patients were screened between 1998 and 2011. Overall about 30% of patients were excluded if they did not meet the angiographic criteria, even though the presence of inducible ischemia or angina, and, about 20% of patients were included without inducible ischemia. CONCLUSION: RCTs have contributed to the confusion between coronary artery disease and ischemic heart disease. This may limit the ability to interpret the results and apply them in practice.

11 Review Should Chronic Total Occlusion Be Treated With Coronary Artery Bypass Grafting? Chronic Total Occlusion Should Not Routinely Be Treated With Coronary Artery Bypass Grafting. 2016

Weintraub, William S / Garratt, Kirk N. ·From the Christiana Care Health System, Newark, DE. wweintraub@christianacare.org. · From the Christiana Care Health System, Newark, DE. ·Circulation · Pubmed #27143549.

ABSTRACT: -- No abstract --

12 Review Comparison of percutaneous coronary intervention with drug eluting stents versus coronary artery bypass grafting in patients with multivessel coronary artery disease: Meta-analysis of six randomized controlled trials. 2015

Fanari, Zaher / Weiss, Sandra A / Zhang, Wei / Sonnad, Seema S / Weintraub, William S. ·Section of Cardiology, Christiana Care Health System, Newark, DE. Electronic address: zfanari@gmail.com. · Section of Cardiology, Christiana Care Health System, Newark, DE. · Value Institute, Christiana Care Health System, Newark, DE. · Section of Cardiology, Christiana Care Health System, Newark, DE; Value Institute, Christiana Care Health System, Newark, DE. ·Cardiovasc Revasc Med · Pubmed #25662779.

ABSTRACT: OBJECTIVE: To compare outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT). BACKGROUND: PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCTs have compared outcomes of the two modalities in patients with multivessel CAD. METHODS: We did a meta-analysis from six RCTs in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively. RESULTS: Compared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR=2.31; 95% CI: [1.80-2.96]; P=<0.0001), lower incidence of stroke (RR=0.35; 95% CI: [0.19-0.62]; P=0.0003), and no difference in death (RR=1.02; 95% CI: [0.77-1.36]; P=0.88) or MI (RR=1.16; 95% CI: [0.72-1.88]; P=0.53). At 5 years, PCI was associated with a higher incidence of death (RR=1.3; 95% CI: [1.10-1.54]; P=0.0026) and MI (RR=2.21; 95% CI: [1.75-2.79]; P=<0.0001). While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients. CONCLUSION: In patients with multi-vessel CAD, PCI with DES is associated with no significant difference in death or MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI.

13 Review Meta-analysis of three randomized controlled trials comparing coronary artery bypass grafting with percutaneous coronary intervention using drug-eluting stenting in patients with diabetes. 2014

Fanari, Zaher / Weiss, Sandra A / Zhang, Wei / Sonnad, Seema S / Weintraub, William S. ·Division of Cardiology, Christiana Care Health System, Newark, DE, USA zfanari@christianacare.org. · Division of Cardiology, Christiana Care Health System, Newark, DE, USA. · Value Institute, Christiana Care Health System, Newark, DE, USA. · Division of Cardiology, Christiana Care Health System, Newark, DE, USA Value Institute, Christiana Care Health System, Newark, DE, USA. ·Interact Cardiovasc Thorac Surg · Pubmed #25185569.

ABSTRACT: OBJECTIVES: Coronary artery bypass grafting (CABG) was found to be the preferred strategy of revascularization in patients with diabetes in the bare-metal stent (BMS) era. The introduction of drug-eluting stents (DESs) led to a significant reduction in the rates of repeat revascularization (RRV) when compared with BMSs. We did a collaborative analysis of data from randomized controlled trials in the contemporary era to compare CABG versus percutaneous coronary intervention using DESs in diabetic patients. METHODS: We performed a systematic review and meta-analysis from randomized trials in the contemporary era comparing PCI with DESs with CABG in diabetic patients with multivessel disease. A comprehensive literature search (1 January 2003 to 18 May 2013) identified randomized controlled trials that reported long-term outcomes comparing PCI using DESs with CABG in 2974 diabetic patients. RESULTS: At 1 year, PCI was associated with a significant increase in the incidence of RRV [2.48 (1.56-3.94); P ≤0.0001], lower incidence of stroke [relative risk (RR) = 0.43 (0.19-0.81); P = 0.017], and no difference in death or myocardial infarction (MI). At 5 years, PCI was still associated with a lower incidence of stroke, but was associated with a significant increase in the incidence of death [RR = 1.36 (1.11-1.66); P = 0.0033] and MI [RR = 2.01 (1.54-2.62); P ≤0.0001]. CONCLUSIONS: In patients with diabetes, PCI was associated with no difference in death and MI at 1 year. However, at 5 years, PCI was associated with a higher incidence of death and MI. PCI was associated with a higher incidence of RRV but a lower incidence of stroke.

14 Review Comparative effectiveness of revascularization strategies in stable ischemic heart disease: current perspective and literature review. 2013

Fanari, Zaher / A Weiss, Sandra / Weintraub, William S. ·Christiana Care Health System, Newark, DE, USA. ·Expert Rev Cardiovasc Ther · Pubmed #24138520.

ABSTRACT: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple randomized controlled trials and observational studies have compared the impact of the two modalities on the patients' quality of life, mortality and morbidity, as well as the cost-effectiveness of these modalities in different clinical setting. CABG is the preferred strategy for revascularizations in patients with multi-vessel disease, especially in those with higher risk secondary to associated diabetes, left ventricular dysfunction or more complex lesions. PCI is a reasonable revascularization modality in patients with ischemia and single or low-risk multi-vessel disease and those with unprotected left main with low complexity anatomy. Compared with PCI, CABG is associated with less repeat revascularization, better quality of life and improved survival in high-risk patients. Although CABG is associated with higher cost, it is probably associated with a reasonable cost per quality-adjusted life-year gained in many patients. Therefore, CABG will often be a cost-effective strategy, especially in patients with high angiographic complexity and/or diabetes.

15 Review Antiplatelet therapy in patients undergoing percutaneous coronary intervention: economic considerations. 2013

Weintraub, William S / Mandel, Leonid / Weiss, Sandra A. · ·Pharmacoeconomics · Pubmed #24022207.

ABSTRACT: Percutaneous coronary intervention (PCI) is one of the most common medical procedures performed for treatment of coronary artery disease. Antiplatelet medications as adjunctive therapy for PCI are used routinely, with indications for specific agents or their combinations varying depending on the clinical scenario. While the cost-effectiveness of well-established agents has been extensively studied, newer drugs have not been evaluated as thoroughly. In addition, the clinical application of some antiplatelet drugs has recently changed, thus making older studies of cost effectiveness less applicable to the current landscape of clinical practice. This article reviews cost-effectiveness considerations of antiplatelet therapies in the treatment of coronary artery disease in patients undergoing PCI. Aspirin, P2Y12 inhibitors including clopidogrel and the newer agents prasugrel and ticagrelor, as well as glycoprotein (GP) IIb/IIIa inhibitors, are discussed. Overall, the use of dual antiplatelet therapy with aspirin and a P2Y12 inhibitor in patients undergoing PCI improves ischaemic outcomes and appears to be cost effective. The few available studies suggest that the recently approved medications prasugrel and ticagrelor are cost-effective alternatives to clopidogrel. However, no direct comparison between these two newer agents is available. The indications for GP IIb/IIIa inhibitors have changed in the current PCI era, and there is a paucity of cost-effectiveness data for their use in contemporary care.

16 Article Myocardial ischemia: From disease to syndrome. 2020

Marzilli, Mario / Crea, Filippo / Morrone, Doralisa / Bonow, Robert O / Brown, David L / Camici, Paolo G / Chilian, William M / DeMaria, Anthony / Guarini, Giacinta / Huqi, Alda / Merz, C Noel Bairey / Pepine, Carl / Scali, Maria Chiara / Weintraub, William S / Boden, William E. ·Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy. Electronic address: mario.marzilli@med.unipi.it. · Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. · Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy. · Department of Medicine, Northwestern University, Chicago, IL, USA. · Cardiovascular Division, Washington University School of Medicine, St Louis, MO, USA. · Vita salute University and San Raffaele Hospital, Milan, Italy. · Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States of America. · Division of Cardiology, University of California, San Diego, San Diego, CA, USA. · Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA. · Division of Cardiology, Department of Medicine, University of Florida, Gainesville, USA. · Outcomes Research, MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, USA. · VA New England Health Care System, Boston, MA, USA. ·Int J Cardiol · Pubmed #32348810.

ABSTRACT: Although current guidelines on the management of stable coronary artery disease acknowledge that multiple mechanisms may precipitate myocardial ischemia, recommended diagnostic, prognostic and therapeutic algorithms are still focused on obstructive epicardial atherosclerotic lesions, and little progress has been made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia. The purpose of this consensus paper is three-fold: 1) to marshal scientific evidence that obstructive atherosclerosis can co-exist with other mechanisms of ischemic heart disease (IHD); 2) to explore how the awareness of multiple precipitating mechanisms could impact on pre-test probability, provocative test results and treatment strategies; and 3) to stimulate a more comprehensive approach to chronic myocardial ischemic syndromes, consistent with the new understanding of this condition.

17 Article Trends in Death Rate 2009 to 2018 Following Percutaneous Coronary Intervention Stratified by Acuteness of Presentation. 2019

Gajanana, Deepakraj / Weintraub, William S / Kolm, Paul / Rogers, Toby / Iantorno, Micaela / Ben-Dor, Itsik / Khalid, Nauman / Shlofmitz, Evan / Khan, Jaffar M / Chen, Yuefeng / Musallam, Anees / Kajita, Alexandre H / Hashim, Hayder / Satler, Lowell F / Torguson, Rebecca / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net. ·Am J Cardiol · Pubmed #31547993.

ABSTRACT: Percutaneous coronary intervention (PCI) has evolved dramatically, along with patient complexity. We studied trends in in-hospital mortality with changes in patient complexity over the last decade stratified by clinical presentation. The study population included all patients presenting to the cardiac catheterization lab between January 2009 and July 2018. Expected in-hospital mortality was calculated using the National Cardiovascular Data Registry CathPCI risk scoring system. Yearly mean in-hospital mortality rates (%) were plotted and smoothed by weighted least squares regression for each presentation: ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndrome (NSTE-ACS), and stable ischemic coronary artery disease (SI CAD). The overall cohort included 13,732 patients who underwent PCI during the study period, of whom 2,142 were for STEMI, 2,836 for NSTE-ACS, and 8,754 for SI CAD. Indications for PCI have changed over time, with more PCIs being performed for NSTE-ACS and STEMI than for SI CAD. NSTE-ACS and STEMI patients had a steady decrease in in-hospital mortality over time compared with SI CAD patients. Overall observed mortality continues to decrease in NSTE-ACS patients, with reduction in the observed mortality rate within the STEMI population to below expected since 2013. Patient complexity has not changed significantly. These results may be attributed to improved patient selection coupled with optimal pharmacotherapy with more robust therapies during procedure and hospitalization.

18 Article Effect of Coronary Anatomy and Myocardial Ischemia on Long-Term Survival in Patients with Stable Ischemic Heart Disease. 2019

Weintraub, William S / Hartigan, Pamela M / Mancini, G B John / Teo, Koon K / Maron, David J / Spertus, John A / Chaitman, Bernard R / Shaw, Leslee J / Berman, Daniel / Boden, William E. ·MedStar Heart & Vascular Institute, Georgetown University, Washington, DC (W.S.W.). · VA Connecticut Healthcare System, West Haven (P.M.H.). · Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (G.B.J.M.). · Department of Medicine, McMaster University Medical Center, Hamilton, ON, Canada (K.K.T.). · Department of Medicine, Stanford University School of Medicine, CA (D.J.M.). · Mid-America Heart Institute, and Department of Biomedical and Health Informatics, University of Missouri Kansas City (J.A.S.). · Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, MO (B.R.C.). · Departments of Medicine and Radiology, Weill Cornell Medical Center, NY (L.J.S.). · Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (D.B.). · Massachusetts Veterans Epidemiology, Research, and Informatics Center (MAVERIC), VA New England Healthcare System, and Division of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine (W.E.B.). ·Circ Cardiovasc Qual Outcomes · Pubmed #30773025.

ABSTRACT: Background The severity of coronary artery disease (CAD) and of ischemia are evaluated to guide therapy, but their relative prognostic importance remains uncertain. Accordingly, we sought to clarify their association with long-term survival in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). Methods and Results Survival data from after the original trial period ended was obtained at 15 Veterans Affairs sites and 13 of 18 United States non-Veterans Affairs sites. Date of death was obtained from the Veterans Affairs system-wide Corporate Data Warehouse and the National Death Index. Of the original 2287 patients in COURAGE, 1370 (60%) had both stress perfusion imaging and quantitative coronary angiography available, with extended survival evaluated in 767 subjects. Survival was calculated by the Kaplan-Meier method, and a Cox proportional-hazards model adjusted for baseline differences. There were 369 all-cause deaths during a median follow-up of 7.9 years (range, 0-15 years). The number of coronary arteries diseased predicted survival (HR, 1.25; 95% CI, 1.09-1.43), whereas severity of ischemia did not (HR, 0.99; 95% CI, 0.80-1.22). Percutaneous coronary intervention did not offer a survival advantage over optimal medical therapy (HR, 0.95; 95% CI, 0.77-1.16) and there was no interaction between therapeutic strategy and number of coronary arteries diseased or severity of ischemia. In fully adjusted models, the number of coronary arteries diseased was not associated with increased mortality. Conclusions In univariate analysis, the number of coronary arteries diseased predicted long-term mortality, but severity of ischemia did not. Adjusted for baseline variables, neither assessment approach predicted mortality. Overall, there was no survival benefit from percutaneous coronary intervention in any subset defined by either angiographic or ischemic severity. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00007657.

19 Article Relation of Sex and Race to Outcomes in Patients Undergoing Percutaneous Intervention With Drug-Eluting Stents. 2019

Iantorno, Micaela / Torguson, Rebecca / Kolm, Paul / Gajanana, Deepakraj / Suddath, William O / Rogers, Toby / Bernardo, Nelson L / Ben-Dor, Itsik / Gai, Jiaxiang / Satler, Lowell F / Garcia-Garcia, Hector M / Weintraub, William S / Waksman, Ron. ·Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. · Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net. ·Am J Cardiol · Pubmed #30595392.

ABSTRACT: Cardiovascular disease is the leading cause of death in men and women, black and white. However, there exists limited outcomes data for women and blacks after percutaneous coronary intervention (PCI). The aim of this study was to evaluate the 1-year major cardiovascular events in patients who underwent PCI based on gender and race. We retrospectively analyzed data that were prospectively collected over 13 years at a large tertiary hospital in the United States. There were 12,050 patients who underwent PCI for both stable disease and acute coronary syndrome from 2003 to 2016. Of those, 1,952 were black men, 6,013 white men, 1,619 black women, and 2,466 white women. Major cardiovascular events at 1 year were assessed, and proportional Cox hazard model analyses were performed to assess outcome adjusted for confounding factors (i.e., age, body mass index, presentation with acute myocardial infarction, diabetes, smoking, history of coronary artery disease, family history of coronary artery disease, hyperlipidemia, hypertension, previous cardiovascular intervention, and chronic kidney disease). At 1 year, white men had significantly lower major cardiovascular events driven by lower rate of death compared with the other groups. Adjusted for confounders, major cardiovascular events were 1.3 to 1.5 times more likely to occur in black men and women and white women than in white men. There was a significant race by gender interaction (p <0.001).

20 Article Optimal medical therapy with or without percutaneous coronary intervention in women with stable coronary disease: A pre-specified subset analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial. 2016

Acharjee, Subroto / Teo, Koon K / Jacobs, Alice K / Hartigan, Pamela M / Barn, Kulpreet / Gosselin, Gilbert / Tanguay, Jean-Francois / Maron, David J / Kostuk, William J / Chaitman, Bernard R / Mancini, G B John / Spertus, John A / Dada, Marcin R / Bates, Eric R / Booth, David C / Weintraub, William S / O'Rourke, Robert A / Boden, William E / Anonymous5470859. ·Einstein Medical Center Philadelphia, Philadelphia, PA. · Hamilton General Hospital/Master University, Hamilton, Canada. · Boston Medical Center, Boston, MA. · VA Connecticut Healthcare System, West Haven, CT. · Geisinger Medical Center, Danville, PA. · Montreal Heart Institute/Université de Montréal, Montreal, QC, Canada. · Vanderbilt University Medical Center, Nashville, TN. · London Health Science Centre, London, ON, Canada. · Saint Louis University School of Medicine, St. Louis, MT. · Vancouver Hospital and Health Science Centre, Vancouver, BC, Canada. · Mid America Heart Institute, Kansas City, MO. · Hartford Hosp, Hartford, CT. · University of Michigan, Ann Arbor, MI. · University of Kentucky Med Center, Lexington, KY. · Christiana Healthcare System and Center for Outcomes Research, Newark, DE. · South Texas Veterans Health Care System-Audie Murphy Campus, San Antonio, TX. · Stratton VA Medical Center, Albany Medical College, Albany, NY. Electronic address: william.boden@va.gov. ·Am Heart J · Pubmed #26920603.

ABSTRACT: OBJECTIVES: To determine whether sex-based differences exist in clinical effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) in patients with stable coronary artery disease. BACKGROUND: A prior pre-specified unadjusted analysis from COURAGE showed that women randomized to PCI had a lower rate of death or myocardial infarction during a median 4.6-year follow-up with a trend for interaction with respect to sex. METHODS: We analyzed outcomes in 338 women (15%) and 1949 men (85%) randomized to PCI plus OMT versus OMT alone after adjustment for relevant baseline characteristics. RESULTS: There was no difference in treatment effect by sex for the primary end point (death or myocardial infarction; HR, 0.89; 95% CI, 0.77-1.03 for women and HR, 1.02, 95% CI 0.96-1.10 for men; P for interaction = .07). Although the event rate was low, a trend for interaction by sex was nonetheless noted for hospitalization for heart failure, with only women, but not men, assigned to PCI experiencing significantly fewer events as compared to their counterparts receiving OMT alone (HR, 0.59; 95% CI, 0.40-0.84, P < .001 for women and HR, 0.86; 95% CI, 0.74-1.01, P = .47 for men; P for interaction = .02). Both sexes randomized to PCI experienced significantly reduced need for subsequent revascularization (HR, 0.72; 95% CI, 0.62-0.83, P < .001 for women; HR, 0.84; 95% CI, 0.79-0.89, P < .001 for men; P for interaction = .02) with evidence of a sex-based differential treatment effect. CONCLUSION: In this adjusted analysis of the COURAGE trial, there were no significant differences in treatment effect on major outcomes between men and women. However, women assigned to PCI demonstrated a greater benefit as compared to men, with a reduction in heart failure hospitalization and need for future revascularization. These exploratory observations require further prospective study.

21 Article Clinical Trials Versus Clinical Practice: When Evidence and Practice Diverge--Should Nondiabetic Patients With 3-Vessel Disease and Stable Ischemic Heart Disease Be Preferentially Treated With CABG? 2015

Kansara, Pranav / Weiss, Sandra / Weintraub, William S / Hann, Matthew C / Tcheng, James / Rab, S Tanveer / Klein, Lloyd W / Anonymous2080849. ·Department of Cardiology, Christiana Care Health System, Newark, Delaware. · Duke University Health System, Durham, North Carolina. · Emory University School of Medicine, Atlanta, Georgia. · Rush Medical College, Chicago, Illinois. Electronic address: lloydklein@comcast.net. ·JACC Cardiovasc Interv · Pubmed #26585614.

ABSTRACT: -- No abstract --

22 Article Effect of baseline exercise capacity on outcomes in patients with stable coronary heart disease (a post hoc analysis of the clinical outcomes utilizing revascularization and aggressive drug evaluation trial). 2015

Padala, Santosh K / Sidhu, Mandeep S / Hartigan, Pamela M / Maron, David J / Teo, Koon K / Spertus, John A / Mancini, G B John / Sedlis, Steven P / Chaitman, Bernard R / Heller, Gary V / Weintraub, William S / Boden, William E. ·Department of Medicine, Albany Medical Center, Albany, New York. · Department of Medicine, Albany Medical Center, Albany, New York; Department of Medicine, Samuel S. Stratton VA Medical Center and Albany Medical College, Albany, New York. · Cooperative Studies Program Coordinating Center, VA Connecticut, West Haven, Connecticut. · Department of Medicine, Stanford University, Stanford, California. · Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, VA New York Harbor, New York University School of Medicine, New York, New York. · Department of Medicine, St. Louis University, St. Louis, Missouri. · Department of Medicine, Intersocietal Accreditation Commission, Elicott City, Maryland. · Department of Medicine, Christiana Care Health System, Newark, Delaware. · Department of Medicine, Albany Medical Center, Albany, New York; Department of Medicine, Samuel S. Stratton VA Medical Center and Albany Medical College, Albany, New York. Electronic address: william.boden@va.gov. ·Am J Cardiol · Pubmed #26410604.

ABSTRACT: The impact of baseline exercise capacity on clinical outcomes in patients with stable ischemic heart disease randomized to an initial strategy of optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI) in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial has not been studied. A post hoc analysis was performed in 1,052 patients of COURAGE (PCI + OMT: n = 527, OMT: n = 525) who underwent exercise treadmill testing at baseline. Patients were categorized into 2 exercise capacity groups based on metabolic equivalents (METs) achieved during baseline exercise treadmill testing (<7 METs: n = 464, ≥7 METs: n = 588) and were followed for a median of 4.6 years. The primary composite end point of death or myocardial infarction was similar in the PCI + OMT group and the OMT group for patients with exercise capacity <7 METs (19.1% vs 16.1%, p = 0.31) and ≥7 METs (13.3% vs 10.3%, p = 0.27). After adjusting for baseline covariates, the hazard ratio (99% confidence interval) for the primary end point for the PCI + OMT group versus the OMT group was 1.42 (0.90 to 2.23, p = 0.05) and for the exercise capacity subgroups of ≥7 METs and <7 METs was 0.75 (0.46 to 1.22, p = 0.13). There was no statistically significant interaction between the original treatment arm allocation (PCI + OMT vs OMT) and baseline exercise capacity. In conclusion, there was no difference in the long-term clinical outcomes in patients with exercise capacity <7 METs compared with ≥7 METs, irrespective of whether they were assigned to initial PCI. Patients with exercise capacity <7 METs did not derive a proportionately greater clinical benefit from PCI + OMT compared with those patients who received OMT alone.

23 Article Acute Coronary Syndrome In HIV Naïve Patient With Low CD4 Count And No Other Significant Risk Factors: Case Report And Literature Review. 2015

Fanari, Zaher / Hammami, Sumaya / Hammami, Muhammad Baraa / Weintraub, William S / Qureshi, Wasif A. ·Department of Cardiology, Christian Care Health System, Newark, Delaware. ·Open J Clin Med Case Rep · Pubmed #26065032.

ABSTRACT: Coronary artery disease (CAD) has become the leading cause of mortality in patients with Human Immunodeficiency Virus (HIV). The typical HIV-infected patient presenting with acute coronary syndrome (ACS) is a man in his mid to late 40s. The most common presentation is an acute myocardial infarction (MI), most often with ST segment elevation. Coronary anatomy seems to be variable, with some studies showing a higher prevalence of single-vessel disease and others showing a higher prevalence of 2- and 3-vessel disease than in controls not infected with HIV.

24 Article Validation of the appropriate use criteria for percutaneous coronary intervention in patients with stable coronary artery disease (from the COURAGE trial). 2015

Bradley, Steven M / Chan, Paul S / Hartigan, Pamela M / Nallamothu, Brahmajee K / Weintraub, William S / Sedlis, Steven P / Dada, Marcin / Maron, David J / Kostuk, William J / Berman, Daniel S / Teo, Koon K / Mancini, G B John / Boden, William E / Spertus, John A. ·Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado. Electronic address: smbradle@gmail.com. · Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Missouri; Department of Medicine, University of Missouri-Kansas City, Missouri. · Department of Medicine, Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, Connecticut. · Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan. · Department of Medicine, Christiana Care Health System, Newark, Delaware. · Division of Cardiology, Department of Medicine, VA New York Harbor Health Care System, New York, New York; Department of Medicine, New York University School of Medicine, New York, New York. · Department of Medicine, Hartford Hospital, Hartford, Connecticut. · Department of Medicine, Stanford University School of Medicine, Stanford, California. · Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. · Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, Western New York VA Healthcare Network, Buffalo, New York; Buffalo General Hospital, SUNY, Buffalo, New York. ·Am J Cardiol · Pubmed #25960375.

ABSTRACT: Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial patients with stable ischemic heart disease randomized to PCI with optimal medical therapy (OMT) or OMT alone. Within appropriateness categories, we compared rates of death, myocardial infarction, revascularization subsequent to initial therapy, and angina-specific health status as determined by the Seattle Angina Questionnaire in patients randomized to PCI + OMT to those randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to the 2012 publication of the AUC, with 1,334 (67.1%) classified as appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There were no significant differences between PCI and OMT alone in the rate of mortality and myocardial infarction by appropriateness classification. Rates of revascularization were significantly lower in patients initially receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65; 95% confidence interval 0.53 to 0.80; p <0.001) or uncertain (hazard ratio 0.49; 95% confidence interval 0.32 to 0.76; p = 0.001). Furthermore, among patients classified as appropriate by the AUC, Seattle Angina Questionnaire scores at 1 month were better in the PCI-treated group compared with the medical therapy group (80 ± 23 vs 75 ± 24 for angina frequency, 73 ± 24 vs 68 ± 24 for physical limitations, and 68 ± 23 vs 60 ± 24 for quality of life; all p <0.01), with differences generally persisting through 12 months. In contrast, health status scores were similar throughout the first year of follow-up in PCI + OMT patients compared with OMT alone in patients classified as uncertain or inappropriate. In conclusion, these findings support the validity of the AUC in efforts to improve health care quality through optimal use of PCI.

25 Article Angiographic validation of the American College of Cardiology Foundation-the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies study. 2014

Chakrabarti, Anjan K / Grau-Sepulveda, Maria V / O'Brien, Sean / Abueg, Cassandra / Ponirakis, Angelo / Delong, Elizabeth / Peterson, Eric / Klein, Lloyd W / Garratt, Kirk N / Weintraub, William S / Gibson, C Michael. ·From the Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (A.K.C., C.M.G.) · PERFUSE Angiographic Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center, Boston, MA (A.K.C., C.A., C.M.G.) · Duke Clinical Research Institute, Duke University, Durham, NC (M.V.G.-S., S.O., E.D., E.P.) · American College of Cardiology, Washington, DC (A.P.) · Division of Internal Medicine, Department of Medicine, Rush University, Chicago, IL (L.W.K.) · Northshore-LIJ/Lenox Hill Hospital, New York, NY (K.N.G.) · and Christiana Care Health System, Newark, DE (W.S.W.). ·Circ Cardiovasc Interv · Pubmed #24496239.

ABSTRACT: BACKGROUND: The goal of this study was to compare angiographic interpretation of coronary arteriograms by sites in community practice versus those made by a centralized angiographic core laboratory. METHODS AND RESULTS: The study population consisted of 2013 American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) records with 2- and 3- vessel coronary disease from 54 sites in 2004 to 2007. The primary analysis compared Registry (NCDR)-defined 2- and 3-vessel disease versus those from an angiographic core laboratory analysis. Vessel-level kappa coefficients suggested moderate agreement between NCDR and core laboratory analysis, ranging from kappa=0.39 (95% confidence intervals, 0.32-0.45) for the left anterior descending artery to kappa=0.59 (95% confidence intervals, 0.55-0.64) for the right coronary artery. Overall, 6.3% (n=127 out of 2013) of those patients identified with multivessel disease at NCDR sites had had 0- or 1-vessel disease by core laboratory reading. There was no directional bias with regard to overcall, that is, 12.3% of cases read as 3-vessel disease by the sites were read as <3-vessel disease by the core laboratory, and 13.9% of core laboratory 3-vessel cases were read as <3-vessel by the sites. For a subset of patients with left main coronary disease, registry overcall was not linked to increased rates of mortality or myocardial infarction. CONCLUSIONS: There was only modest agreement between angiographic readings in clinical practice and those from an independent core laboratory. Further study will be needed because the implications for patient management are uncertain.

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