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Coronary Artery Disease: HELP
Articles from Cornell University
Based on 212 articles published since 2008
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These are the 212 published articles about Coronary Artery Disease that originated from Cornell University during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
1 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

2 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 --

3 Editorial Cardiovascular computed tomographic angiography: Entering into the 5th stage. 2018

Min, James K / Feuchtner, Gudrun M / Villines, Todd C. ·New York-Presbyterian Hospital and the Weill Cornell Medical College, Department of Radiology, 413 E. 69th Street, Suite 108, New York City, NY 10021, United States. Electronic address: jkm2001@med.cornell.edu. · Medical University Innsbruck, Innsbruck, Austria. · Uniformed Services University School of Medicine and the Walter Reed Medical Center, Bethesda, MD, United States. ·J Cardiovasc Comput Tomogr · Pubmed #29759895.

ABSTRACT: -- No abstract --

4 Editorial Look Backwards But Live Forwards. 2017

Min, James K. ·Departments of Radiology and Medicine, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York. Electronic address: runone123@gmail.com. ·JACC Cardiovasc Imaging · Pubmed #27085450.

ABSTRACT: -- No abstract --

5 Editorial CAD-RADS: A Giant First Step Toward a Common Lexicon? 2016

Chandrashekhar, Y / Min, James K / Hecht, Harvey / Narula, Jagat. ·University of Minnesota School of Medicine, and VA Medical Center, Minneapolis, Minnesota. · Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York. · Icahn School of Medicine at Mount Sinai, New York, New York. · Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: narula@mountsinai.org. ·JACC Cardiovasc Imaging · Pubmed #27609154.

ABSTRACT: -- No abstract --

6 Editorial Assessing Hemodynamically Significant CAD by Difference in Contrast Opacification of CT Angiograms: An Exercise in Seeing and Believing. 2016

Min, James K. ·Departments of Radiology and Medicine, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York. Electronic address: runone123@gmail.com. ·JACC Cardiovasc Imaging · Pubmed #27372015.

ABSTRACT: -- No abstract --

7 Editorial A PROMISE Fulfilled That Quality-of-Life Assessments Afford Incremental Value to Coronary Artery Disease Management. 2016

Schulman-Marcus, Joshua / Boden, William E. ·From Weill Cornell Medical College, New York (J.S.-M.) · and Albany Stratton VA Medical Center and Albany Medical College, NY (W.E.B.). ·Circulation · Pubmed #27143677.

ABSTRACT: -- No abstract --

8 Editorial Diagnosis of Coronary Disease and Icing on the Cake. 2015

Min, James K / Chandrashekhar, Y / Narula, Jagat. ·Departments of Radiology and Medicine, Weill Cornell Medical College, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York. · University of Minnesota and VA Medical Center, Minneapolis, Minnesota. · Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: narula@mountsinai.org. ·JACC Cardiovasc Imaging · Pubmed #26381774.

ABSTRACT: -- No abstract --

9 Editorial FFR Derived From Coronary CT Angiography: Solving the Calcification Dilemma of Coronary CT Angiography. 2015

Budoff, Matthew J / Min, James K. ·Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California. Electronic address: mbudoff@labiomed.org. · Departments of Radiology and Medicine, Weill Cornell Medical College, New York, New York; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital, New York, New York. ·JACC Cardiovasc Imaging · Pubmed #26381767.

ABSTRACT: -- No abstract --

10 Editorial On diet, exercise … and arterial grafting. 2015

Gaudino, Mario. ·Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, USA; Department of Cardiovascular Sciences, Catholic University, Rome, Italy. Electronic address: mfg9004@med.cornell.edu. ·Int J Cardiol · Pubmed #25897914.

ABSTRACT: -- No abstract --

11 Editorial Breast arterial calcification and cardiovascular risk. 2015

Barlow, David H. ·The University of Glasgow Glasgow, United Kingdom Weill Cornell Medical College in Qatar Doha, Qatar. ·Menopause · Pubmed #25584738.

ABSTRACT: -- No abstract --

12 Editorial Comparing outcomes and costs following cardiovascular imaging: a SPARC…but further illumination is needed. 2014

Villines, Todd C / Min, James K. ·Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, Maryland. Electronic address: todd.c.villines@health.mil. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. ·J Am Coll Cardiol · Pubmed #24412452.

ABSTRACT: -- No abstract --

13 Editorial The synergy between percutaneous therapies and noninvasive diagnostic imaging. 2013

Min, James K. ·Departments of Radiology and Medicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, New York. Electronic address: jkm2001@med.cornell.edu. ·JACC Cardiovasc Interv · Pubmed #24156962.

ABSTRACT: -- No abstract --

14 Review Racial Disparities in the Cardiac Computed Tomography Assessment of Coronary Artery Disease: Does Gender Matter. 2019

El-Menyar, Ayman / Abuzaid, Ahmed / Elbadawi, Ayman / McIntyre, Matthew / Latifi, Rifat. ·From the Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. · Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY. · Cardiology Department, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE. · Department of Internal Medicine, Rochester General Hospital, Rochester, NY. · New York Medical College, Valhalla, NY. · Department of Surgery, Westchester Medical Center, Valhalla, NY. ·Cardiol Rev · Pubmed #30520779.

ABSTRACT: Coronary heart disease (CHD) represents a significant healthcare burden in terms of hospital resources, morbidity, and mortality. Primary prevention and early detection of risk factors for the development of CHD are pivotal to successful intervention programs and prognostication. Yet, there remains a paucity of evidence regarding differences in the assessment of these risk factors and the tools of assessment among different ethnicities. We conducted a narrative review to assess the utility of cardiac computed tomography, particularly coronary artery calcification (CAC), in different ethnicities. We also looked to see whether age, sex, comorbidities, and genetic background have peculiar influences on CAC. In this review, we highlight some of the pivotal studies regarding the question of CAC in relation to the development of CHD among different ethnicities. We identify several key trends in the literature showing that although African Americans have high rates of CHD, their risk of CAC may be relatively lower compared with other ethnicities. Similarly, South Asian patients may be at a high risk for adverse cardiac events due to elevated CAC. We also note that several studies are limited by small sample size and were based on 1 large cohort study. Future studies should include a large international prospective cohort to truly evaluate the effects of ethnicity on CAC and CHD risk. To appropriately apply CAC in the clinical practice, the variations in its scoring based on a subject's age, sex, comorbidity, and ethnicity should be addressed and interpreted beforehand.

15 Review The Journal of Cardiovascular Computed Tomography year in review - 2018. 2018

Al'Aref, Subhi J / Mrsic, Zorana / Feuchtner, Gudrun / Min, James K / Villines, Todd C. ·Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY, USA. · Cardiac CT Program and Cardiovascular Research, Walter Reed National Military Medical Center, Bethesda, MD, USA. · Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. · Cardiac CT Program and Cardiovascular Research, Walter Reed National Military Medical Center, Bethesda, MD, USA. Electronic address: todd.c.villines.mil@mail.mil. ·J Cardiovasc Comput Tomogr · Pubmed #30361179.

ABSTRACT: Since the introduction of ≥64 detector row coronary computed tomography angiography (CCTA) as a noninvasive imaging modality, various clinical trials have established its diagnostic performance and prognostic significance when compared to other anatomic and functional tests for coronary artery disease (CAD). CCTA has been increasingly utilized for a wide range of clinical scenarios, driven by both advances in technology as well as data showing improvement in outcomes. Accumulating evidence has continually refined and supported the central role of CCTA within clinical care, and this year has witnessed continued evolution of the application of CCTA within healthcare and translational research. The purpose of the present review is to summarize the year of the Journal of Cardiovascular Computed Tomography (JCCT), highlighting the evidence base supporting the appropriate application of cardiac computed tomography across numerous clinical domains.

16 Review Percutaneous coronary intervention or coronary artery bypass graft in left main coronary artery disease: a comprehensive meta-analysis of adjusted observational studies and randomized controlled trials. 2018

Bertaina, Maurizio / De Filippo, Ovidio / Iannaccone, Mario / Colombo, Antonio / Stone, Gregg / Serruys, Patrick / Mancone, Massimo / Omedè, Pierluigi / Conrotto, Federico / Pennone, Mauro / Kimura, Takeshi / Kawamoto, Hiroyoshi / Zoccai, Giuseppe Biondi / Sheiban, Imad / Templin, Christian / Benedetto, Umberto / Cavalcante, Rafael / D'Amico, Maurizio / Gaudino, Mario / Moretti, Claudio / Gaita, Fiorenzo / D'Ascenzo, Fabrizio. ·Division of Cardiology, Città Della Salute e della Scienza, Molinette Hospital, Turin. · Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy. · Cardiovascular Research and Education Columbia University Medical Center, Presbyterian Hospital, New York, USA. · Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. · Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, University 'La Sapienza' of Rome, Rome, Italy. · Department of Cardiovascular Medicine, Kyoto University, Japan. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina. · Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli. · Cardiology Department, Pederzoli Hospital, Verona, Italy. · University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom. · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA. ·J Cardiovasc Med (Hagerstown) · Pubmed #30095584.

ABSTRACT: BACKGROUND: Treatment of patients with ULMCA (unprotected left main coronary artery disease) with percutaneous coronary intervention (PCI) has been compared with coronary artery bypass graft (CABG), without conclusive results. METHODS: All randomized controlled trials (RCTs) and observational studies with multivariate analysis comparing PCI and CABG for ULMCA were included. Major cardiovascular events (MACEs, composite of all-cause death, MI, definite or probable ST, target vessel revascularization and stroke) were the primary end points, whereas its single components were the secondary ones, along with stent thrombosis, graft occlusion and in-hospital death and stroke. Subgroup analyses were performed according to Syntax score. RESULTS: Six RCTs (4717 patients) and 20 observational studies with multivariate adjustment (14 597 patients) were included. After 5 (3-5.5) years, MACE rate was higher for PCI [odds ratio (OR) 1.10, 95% confidence interval (CI) 1.07-1.14], without difference in death, whereas more relevant risk of MI was because of observational studies. Coronary stenting increased risk of revascularization (OR 1.52; 95% CI 1.34-1.72). At meta-regression, performance of PCI was improved by use of intra-coronary imaging and worsened by first generation stents, whereas two arterial grafts increased benefit of CABG. For patients with Syntax score less than 22, MACE rates did not differ, whereas for higher values, CABG reduced MACE because of lower risk of revascularization. Incidence of graft occlusion was 3.24% (2.25-4.23), whereas 2.13% (1.28-2.98: all CI 95%) of patients experienced stent thrombosis. CONCLUSION: Surgical revascularization reduces risk of revascularization for ULMCA patients, especially for those with Syntax score greater than 22, with a higher risk of in-hospital death. Intra-coronary imaging and use of arterial grafts improved performance of revascularization strategies.

17 Review Machine learning in cardiac CT: Basic concepts and contemporary data. 2018

Singh, Gurpreet / Al'Aref, Subhi J / Van Assen, Marly / Kim, Timothy Suyong / van Rosendael, Alexander / Kolli, Kranthi K / Dwivedi, Aeshita / Maliakal, Gabriel / Pandey, Mohit / Wang, Jing / Do, Virginie / Gummalla, Manasa / De Cecco, Carlo N / Min, James K. ·Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, USA. · Division of Cardiovascular Imaging, Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands. · Division of Cardiovascular Imaging, Medical University of South Carolina, Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Charleston, SC, USA. · Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, USA. Electronic address: jkm2001@med.cornell.edu. ·J Cardiovasc Comput Tomogr · Pubmed #29754806.

ABSTRACT: Propelled by the synergy of the groundbreaking advancements in the ability to analyze high-dimensional datasets and the increasing availability of imaging and clinical data, machine learning (ML) is poised to transform the practice of cardiovascular medicine. Owing to the growing body of literature validating both the diagnostic performance as well as the prognostic implications of anatomic and physiologic findings, coronary computed tomography angiography (CCTA) is now a well-established non-invasive modality for the assessment of cardiovascular disease. ML has been increasingly utilized to optimize performance as well as extract data from CCTA as well as non-contrast enhanced cardiac CT scans. The purpose of this review is to describe the contemporary state of ML based algorithms applied to cardiac CT, as well as to provide clinicians with an understanding of its benefits and associated limitations.

18 Review Role of CYP2C19 genotype testing in clinical use of clopidogrel: is it really useful? 2018

Zeb, Irfan / Krim, Nassim / Bella, Jonathan. ·a Division of Cardiology, Department of Medicine , Bronxcare Health System , Bronx , NY , USA. · b Division of Cardiology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA. · c Division of Cardiology, Department of Medicine , Weill Cornell Medicine , New York , NY , USA. ·Expert Rev Cardiovasc Ther · Pubmed #29589775.

ABSTRACT: INTRODUCTION: P2Y12 inhibitors, including clopidogrel have become an integral part of treatment for patients receiving coronary stent placement as a result of stable coronary artery disease or acute coronary syndromes (ACS) and also for medically managed ACS patients. Areas covered: Clopidogrel efficacy can be significantly modified by polymorphism of CYP2C19 genotype (more than 25 allelic variants) involved in its metabolism that can adversely affect its anti-platelet activity. As a result, a substantial number of patients (20-30%) with ACS show an inadequate response to clopidogrel despite a standardized dosing regimen. Experts commentary: Currently, there is conflicting evidence in regards to the use of CYP2C19 genotyping to identify poor responders to clopidogrel in clinical practice. ACC/AHA guidelines do not recommend routine use of CYP2C19 in clinical practice, whereas Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines recommend its use to identify poor/intermediate metabolizers of Clopidogrel and suggest alternative P2Y12 inhibitors among ACS patients undergoing percutaneous coronary intervention. This review article will look at the literature evidence for the use of CYP2C19 genotyping in clinical practice.

19 Review Mechanisms, Consequences, and Prevention of Coronary Graft Failure. 2017

Gaudino, Mario / Antoniades, Charalambos / Benedetto, Umberto / Deb, Saswata / Di Franco, Antonino / Di Giammarco, Gabriele / Fremes, Stephen / Glineur, David / Grau, Juan / He, Guo-Wei / Marinelli, Daniele / Ohmes, Lucas B / Patrono, Carlo / Puskas, John / Tranbaugh, Robert / Girardi, Leonard N / Taggart, David P / Anonymous2570925. ·From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.) · Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.) · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.) · Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.) · University "G. D'Annunzio," Chieti, Italy (G.D.G., D.M.) · Division of Cardiac Surgery, Ottawa Heart Institute, Canada (D.G., J.G.) · TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (G.-W.H.) · Department of Pharmacology, Catholic University School of Medicine, Rome, Italy (C.P.) · and Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai,New York (J.P.). ·Circulation · Pubmed #29084780.

ABSTRACT: Graft failure occurs in a sizeable proportion of coronary artery bypass conduits. We herein review relevant current evidence to give an overview of the incidence, pathophysiology, and clinical consequences of this multifactorial phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are different mechanisms associated with graft failure. Intrinsic morphological and functional features of the bypass conduits play a role in determining failure. Similarly, characteristics of the target coronary vessel, such as the severity of stenosis, the diameter, the extent of atherosclerotic burden, and previous endovascular interventions, are important determinants of graft outcome and must be taken into consideration at the time of surgery. Technical factors, such as the method used to harvest the conduits, the vasodilatory protocol, the storage solution, and the anastomotic technique, also play a major role in determining graft success. Furthermore, systemic atherosclerotic risk factors, such as age, sex, diabetes mellitus, hypertension, and dyslipidemia, have been variably associated with graft failure. The failure of a coronary graft is not always correlated with adverse clinical events, which vary according to the type, location, and reason for failed graft. Intraoperative flow verification and secondary prevention using antiplatelet and lipid-lowering agents can help reducing the incidence of graft failure.

20 Review Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol. 2017

Gaudino, Mario / Alexander, John H / Bakaeen, Faisal G / Ballman, Karla / Barili, Fabio / Calafiore, Antonio Maria / Davierwala, Piroze / Goldman, Steven / Kappetein, Peter / Lorusso, Roberto / Mylotte, Darren / Pagano, Domenico / Ruel, Marc / Schwann, Thomas / Suma, Hisayoshi / Taggart, David P / Tranbaugh, Robert F / Fremes, Stephen. ·Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA. · Duke Clinical Research Institute, Duke Health, Durham, NC, USA. · Cleveland Clinic Foundation, Cleveland, OH, USA. · Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA. · Department of Cardiovascular Surgery, S. Croce e Carle Hospital, Cuneo, Italy. · Fondazione Giovanni Paolo II, Campobasso, Italy. · Herzzentrum Leipzig, Leipzig, Germany. · Department of Medicine, University of Arizona, Tucson, AZ, USA. · Thoraxcenter, Erasmus MC, Rotterdam, Netherlands. · Maastricht University Medical Centre, Maastricht, Netherlands. · Galway University Hospitals, Galway, Ireland. · University Hospital Birmingham, Birmingham, UK. · University of Ottawa Heart Institute, Ottawa, ON, Canada. · The University of Toledo, Toledo, OH, USA. · Suma Heart Clinic, Tokyo, Japan. · University of Oxford, Oxford, UK. · Sunnybrook Health Science, University of Toronto, Toronto, ON, Canada. ·Eur J Cardiothorac Surg · Pubmed #29059371.

ABSTRACT: SUMMARY: The primary hypothesis of the ROMA trial is that in patients undergoing primary isolated non-emergent coronary artery bypass grafting, the use of 2 or more arterial grafts compared with a single arterial graft (SAG) is associated with a reduction in the composite outcome of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary hypothesis is that in these patients, the use of 2 or more arterial grafts compared with a SAG is associated with improved survival. The ROMA trial is a prospective, unblinded, randomized event-driven multicentre trial comprising at least 4300 subjects. Patients younger than 70 years with left main and/or multivessel disease will be randomized to a SAG or multiple arterial grafts to the left coronary system in a 1:1 fashion. Permuted block randomization stratified by the centre and the type of second arterial graft will be used. The primary outcome will be a composite of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary outcome will be all-cause mortality. The primary safety outcome will be a composite of death from any cause, any stroke and any myocardial infarction. In all patients, 1 internal thoracic artery will be anastomosed to the left anterior descending coronary artery. For patients randomized to the SAG group, saphenous vein grafts will be used for all non-left anterior descending target vessels. For patients randomized to the multiple arterial graft group, the main target vessel of the lateral wall will be grafted with either a radial artery or a second internal thoracic artery. Additional grafts for the multiple arterial graft group can be saphenous veins or supplemental arterial conduits. To detect a 20% relative reduction in the primary outcome, with 90% power at 5% alpha and assuming a time-to-event analysis, the sample size must include 845 events (and 3650 patients). To detect a 20% relative reduction in the secondary outcome, with 80% power at 5% alpha, the sample size must include 631 events (and 3650 patients). To be conservative, the sample size will be set at 4300 patients. The primary outcome will be tested according to the intention-to-treat principle. The primary analysis will be a Cox proportional hazards regression model, with the treatment arm included as a covariate. If non-proportional hazards are observed, alternatives to Cox proportional hazards regression will be explored.

21 Review Coronary Artery Calcification: From Mechanism to Molecular Imaging. 2017

Nakahara, Takehiro / Dweck, Marc R / Narula, Navneet / Pisapia, David / Narula, Jagat / Strauss, H William. ·Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: takehironakahara@gmail.com. · Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom. · Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York. · Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. · Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York. ·JACC Cardiovasc Imaging · Pubmed #28473100.

ABSTRACT: Vascular calcification is a hallmark of atherosclerosis. The location, density, and confluence of calcification may change portions of the arterial conduit to a noncompliant structure. Calcifications may also seed the cap of a thin cap fibroatheroma, altering tensile forces on the cap and rendering the lesion prone to rupture. Many local and systemic factors participate in this process, including hyperlipidemia, ongoing inflammation, large necrotic cores, and diabetes. Vascular cells can undergo chondrogenic or osteogenic differentiation, causing mineralization of membranous bone and formation of endochondral bone. Calcifying vascular cells are derived from local smooth muscle cells and circulating hematopoietic stem cells (especially in intimal calcification). Matrix vesicles in the extracellular space of the necrotic core serve as a nidus for calcification. Although coronary calcification is a marker of coronary atheroma, dense calcification (>400 HU) is usually associated with stable plaques. Conversely, microcalcification (often also referred to as spotty calcification) is more commonly an accompaniment of vulnerable plaques. Recent studies have suggested that microcalcification in the fibrous cap may increase local tissue stress (depending on the proximity of one microcalcific locus to another, and the orientation of the microcalcification in reference to blood flow), resulting in plaque instability. It has been proposed that positron emission tomography imaging with sodium fluoride may identify early calcific deposits and hence high-risk plaques.

22 Review New-Generation Coronary Stents: Current Data and Future Directions. 2017

Kalra, Ankur / Rehman, Hasan / Khera, Sahil / Thyagarajan, Braghadheeswar / Bhatt, Deepak L / Kleiman, Neal S / Yeh, Robert W. ·Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA. · Weill Cornell Medical College, New York, NY, USA. · Safety, Quality, Informatics and Leadership Program, 2016-17, Harvard Medical School, Boston, MA, USA. · New York Medical College, White Plains, NY, USA. · Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA. · Brigham and Women's Heart and Vascular Center, Harvard Medical School, Boston, MA, USA. · The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. ryeh@bidmc.harvard.edu. ·Curr Atheroscler Rep · Pubmed #28220461.

ABSTRACT: PURPOSE OF REVIEW: Drug-eluting stents are the mainstay in the treatment of coronary artery disease using percutaneous coronary intervention. Innovations developed to overcome the limitations of prior generations of stents include biodegradable polymer stents, drug-eluting stents without a polymer, and bioabsorbable scaffolds. Our review briefly discusses the clinical profiles of first- and second-generation coronary stents, and provides an up-to-date overview of design, technology, and clinical safety and efficacy profiles of newer generation coronary stents discussing the relevant clinical trials in this rapidly evolving area of interventional cardiology. RECENT FINDINGS: Drug-eluting stents have previously been shown to be superior to bare metal stents. Second-generation everolimus-eluting stents have proven to have superior outcomes compared with first-generation paclitaxel- and sirolimus-eluting stents, and the second-generation zotarolimus-eluting stents appear to be similar to the everolimus-eluting stents, though with a lesser degree of evidence. Stents with biodegradable polymers have not been shown to be superior to everolimus-eluting stents. Bioabsorbable scaffolds have not demonstrated better outcomes than current standard treatment with second-generation drug-eluting stents but have showed a concerning signal of late and very late stent thrombosis. Everolimus-eluting stents have the most favorable outcomes in terms of safety as well as efficacy in patients undergoing percutaneous coronary intervention. Newer innovations such as biodegradable polymers and bioabsorbable scaffolds lack clinical data to replace second-generation drug-eluting stents as standard of care.

23 Review Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity-Matched Studies. 2017

Gaudino, Mario / Puskas, John D / Di Franco, Antonino / Ohmes, Lucas B / Iannaccone, Mario / Barbero, Umberto / Glineur, David / Grau, Juan B / Benedetto, Umberto / D'Ascenzo, Fabrizio / Gaita, Fiorenzo / Girardi, Leonard N / Taggart, David P. ·From Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY (M.G., A.D.F., L.B.O., L.N.G.) · Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.D.P.) · Città della Scienza e della Salute, Department of Cardiology, University of Turin, Italy (M.I., U.B., F.D., F.G.) · Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (D.G., J.B.G.) · Bristol Heart Institute, University of Bristol, UK (U.B.) · and Department of Cardiac Surgery, John Radcliffe Hospital, University of Oxford, UK (D.P.T.). ·Circulation · Pubmed #28119382.

ABSTRACT: BACKGROUND: Little evidence shows whether a third arterial graft provides superior outcomes compared with the use of 2 arterial grafts in patients undergoing coronary artery bypass grafting. A meta-analysis of all the propensity score-matched observational studies comparing the long-term outcomes of coronary artery bypass grafting with the use of 2-arterial versus 3-arterial grafts was performed. METHODS: A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Long-term mortality in the propensity score-matched populations was the primary end point. Secondary end points were in-hospital/30-day mortality for the propensity score-matched populations and long-term mortality for the unmatched populations. In the matched population, time-to-event outcome for long-term mortality was extracted as hazard ratios, along with their variance. Statistical pooling of survival (time-to-event) was performed according to a random effect model, computing risk estimates with 95% confidence intervals. RESULTS: Eight propensity score-matched studies reporting on 10 287 matched patients (2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The use of 3 arterial grafts was not statistically associated with early mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22; CONCLUSIONS: The use of a third arterial conduit in patients with coronary artery bypass grafting is not associated with higher operative risk and is associated with superior long-term survival, irrespective of sex and diabetic mellitus status.

24 Review Sex differences in nonobstructive coronary artery disease: Recent insights and substantial knowledge gaps. 2017

Paul, Tracy K / Sivanesan, Kaartiga / Schulman-Marcus, Joshua. ·Greenberg Division of Cardiology, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY. · Division of Cardiology, Albany Medical Center, 47 New Scotland Ave, Albany, NY 12208. Electronic address: schulmj1@mail.amc.edu. ·Trends Cardiovasc Med · Pubmed #27617797.

ABSTRACT: The existence of sex differences in the epidemiology, presentation, diagnosis, and management of coronary artery disease (CAD) has been a subject of growing inquiry for the past several decades. The prevailing paradigm is that the prevalence of anatomically obstructive disease of the epicardial coronary arteries is less common in women than similarly aged men, while nonobstructive and microvascular ischemic disease is more prevalent in women. Although both "patterns" of coronary atherosclerosis are associated with angina and cardiovascular events, the dominant diagnostic and therapeutic tools used in cardiology have focused on the male-predominant pattern of anatomically obstructive epicardial CAD. This has raised justified concerns about the under-diagnosis and under-treatment of symptomatic women with nonobstructive CAD. However, as recent research has begun to highlight the importance of nonobstructive CAD and coronary physiology in men as well as women, adjustments to this paradigm and greater attention to nonobstructive CAD are necessary. The present article seeks to review key insights as well as substantial knowledge gaps regarding sex differences and nonobstructive CAD.

25 Review Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. 2017

Danad, Ibrahim / Szymonifka, Jackie / Twisk, Jos W R / Norgaard, Bjarne L / Zarins, Christopher K / Knaapen, Paul / Min, James K. ·Department of Radiology, Weill Cornell Medical College, New York, NY, USA. · Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, New York, NY, USA. · Department of Epidemiology and Biostatistics, VU University Medical Center, VU University, Amsterdam, The Netherlands. · Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. · Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. · HeartFlow, Inc., Redwood City, CA, USA. · Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. ·Eur Heart J · Pubmed #27141095.

ABSTRACT: Aims: The aim of this study was to determine the diagnostic performance of single-photon emission computed tomography (SPECT), stress echocardiography (SE), invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), fractional flow reserve (FFR) derived from CCTA (FFRCT), and cardiac magnetic resonance (MRI) imaging when directly compared with an FFR reference standard. Method and results: PubMed and Web of Knowledge were searched for investigations published between 1 January 2002 and 28 February 2015. Studies performing FFR in at least 75% of coronary vessels for the diagnosis of ischaemic coronary artery disease (CAD) were included. Twenty-three articles reporting on 3788 patients and 5323 vessels were identified. Meta-analysis was performed for pooled sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratio, and summary receiver operating characteristic curves. In contrast to ICA, CCTA, and FFRCT reports, studies evaluating SPECT, SE, and MRI were largely retrospective, single-centre and with generally smaller study samples. On a per-patient basis, the sensitivity of CCTA (90%, 95% CI: 86-93), FFRCT (90%, 95% CI: 85-93), and MRI (90%, 95% CI: 75-97) were higher than for SPECT (70%, 95% CI: 59-80), SE (77%, 95% CI: 61-88), and ICA (69%, 95% CI: 65-75). The highest and lowest per-patient specificity was observed for MRI (94%, 95% CI: 79-99) and for CCTA (39%, 95% CI: 34-44), respectively. Similar specificities were noted for SPECT (78%, 95% CI: 68-87), SE (75%, 95% CI: 63-85), FFRCT (71%, 95% CI: 65-75%), and ICA (67%, 95% CI: 63-71). On a per-vessel basis, the highest sensitivity was for CCTA (pooled sensitivity, 91%: 88-93), MRI (91%: 84-95), and FFRCT (83%, 78-87), with lower sensitivities for ICA (71%, 69-74), and SPECT (57%: 49-64). Per-vessel specificity was highest for MRI (85%, 79-89), FFRCT (78%: 78-81), and SPECT (75%: 69-80), whereas ICA (66%: 64-68) and CCTA (58%: 55-61) yielded a lower specificity. Conclusions: In this meta-analysis comparing cardiac imaging methods directly to FFR, MRI had the highest performance for diagnosis of ischaemia-causing CAD, with lower performance for SPECT and SE. Anatomic methods of CCTA and ICA yielded lower specificity, with functional assessment of coronary atherosclerosis by SE, SPECT, and FFRCT improving accuracy.

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