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Coronary Artery Disease: HELP
Articles from University of Ottawa
Based on 222 articles published since 2008
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These are the 222 published articles about Coronary Artery Disease that originated from University of Ottawa during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
1 Guideline ACR Appropriateness Criteria 2018

Anonymous2701124 / Shah, Amar B / Kirsch, Jacobo / Bolen, Michael A / Batlle, Juan C / Brown, Richard K J / Eberhardt, Robert T / Hurwitz, Lynne M / Inacio, Joao R / Jin, Jill O / Krishnamurthy, Rajesh / Leipsic, Jonathon A / Rajiah, Prabhakar / Singh, Satinder P / White, Richard D / Zimmerman, Stefan L / Abbara, Suhny. ·Westchester Medical Center, Valhalla, New York. Electronic address: ashah27@northwell.edu. · Panel Chair, Cleveland Clinic Florida, Weston, Florida. · Panel Vice-Chair, Cleveland Clinic, Cleveland, Ohio. · Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida. · University of Michigan Health System, Ann Arbor, Michigan. · Boston University School of Medicine, Boston, Massachusetts; American College of Cardiology. · Duke University Medical Center, Durham, North Carolina. · The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. · Northwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians. · Nationwide Children's Hospital, Columbus, Ohio. · St. Paul's Hospital, Vancouver, British Columbia, Canada. · UT Southwestern Medical Center, Dallas, Texas. · University of Alabama at Birmingham, Birmingham, Alabama. · The Ohio State University Wexner Medical Center, Columbus, Ohio. · Johns Hopkins Medical Institute, Baltimore, Maryland. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. ·J Am Coll Radiol · Pubmed #30392597.

ABSTRACT: Chronic chest pain (CCP) of a cardiac etiology is a common clinical problem. The diagnosis and classification of the case of chest pain has rapidly evolved providing the clinician with multiple cardiac imaging strategies. Though scintigraphy and rest echocardiography remain as appropriate imaging tools in the diagnostic evaluation, new technology is available. Current evidence supports the use of alternative imaging tests such as coronary computed tomography angiography (CCTA), cardiac MRI (CMRI), or Rb-82 PET/CT. Since multiple imaging modalities are available to the clinician, the most appropriate noninvasive imaging strategy will be based upon the patient's clinical presentation and clinical status. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

2 Guideline Canadian Cardiovascular Society guidelines for the diagnosis and management of stable ischemic heart disease. 2014

Mancini, G B John / Gosselin, Gilbert / Chow, Benjamin / Kostuk, William / Stone, James / Yvorchuk, Kenneth J / Abramson, Beth L / Cartier, Raymond / Huckell, Victor / Tardif, Jean-Claude / Connelly, Kim / Ducas, John / Farkouh, Michael E / Gupta, Milan / Juneau, Martin / O'Neill, Blair / Raggi, Paolo / Teo, Koon / Verma, Subodh / Zimmermann, Rodney / Anonymous3830801. ·Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca. · Department of Medicine, Montreal Heart Institute, University of Montreal, Montréal, Québec, Canada. · Department of Medicine, Ottawa Heart Institute, Ottawa, Ontario, Canada. · Department of Medicine, University of Western Ontario, London, Ontario, Canada. · Department of Medicine, University of Calgary, Calgary, Alberta, Canada. · Vancouver Island Health Authority, Victoria, British Columbia, Canada. · Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. · Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Medicine, University Health Network Hospitals, University of Toronto, Toronto, Onario, Canada. · Department of Medicine, McMaster University, Hamilton, Ontario, Canada. · Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. · Department of Medicine, Regina Qu'Appelle Health Region, University of Saskatchewan, Regina, Saskatchewan, Canada. ·Can J Cardiol · Pubmed #25064578.

ABSTRACT: This overview provides a guideline for the management of stable ischemic heart disease. It represents the work of a primary and secondary panel of participants from across Canada who achieved consensus on behalf of the Canadian Cardiovascular Society. The suggestions and recommendations are intended to be of relevance to primary care and specialist physicians with an emphasis on rational deployment of diagnostic tests, expedited implementation of long- and short-term medical therapy, timely consideration of revascularization, and practical follow-up measures.

3 Guideline Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. 2014

Boodhwani, Munir / Andelfinger, Gregor / Leipsic, Jonathon / Lindsay, Thomas / McMurtry, M Sean / Therrien, Judith / Siu, Samuel C / Anonymous6800795. ·Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: mboodhwani@ottawaheart.ca. · Department of Pediatrics, University of Montreal, Montreal, Québec, Canada. · Department of Radiology, University of British Colombia, Vancouver, British Colombia, Canada. · Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada. · Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada. · Division of Cardiology, McGill University, Montreal, Québec, Canada. · Division of Cardiology, Western University, London, Ontario, Canada. ·Can J Cardiol · Pubmed #24882528.

ABSTRACT: This Canadian Cardiovascular Society position statement aims to provide succinct perspectives on key issues in the management of thoracic aortic disease (TAD). This document is not a comprehensive overview of TAD and important elements of the epidemiology, presentation, diagnosis, and management of acute aortic syndromes are deliberately not discussed; readers are referred to the 2010 guidelines published by the American Heart Association, American College of Cardiology, American Association for Thoracic Surgery, and other stakeholders. Rather, this document is a practical guide for clinicians managing adult patients with TAD. Topics covered include size thresholds for surgical intervention, emerging therapies, imaging modalities, medical and lifestyle management, and genetics of TAD. The primary panel consisted of experts from a variety of disciplines that are essential for comprehensive management of TAD patients. The methodology involved a focused literature review with an emphasis on updates since 2010 and the use of Grading of Recommendations Assessment, Development, and Evaluation methodology to arrive at specific recommendations. The final document then underwent review by a secondary panel. This document aims to provide recommendations for most patients and situations. However, the ultimate judgement regarding the management of any individual patients should be made by their health care team.

4 Guideline The 'what, when, where, who and how?' of cardiac computed tomography in 2009: guidelines for the clinician. 2009

Chow, B J W / Larose, E / Bilodeau, S / Ellins, M L / Galiwango, P / Kass, M / Sheth, T / Jassal, D S / Kirkpatrick, I D C / Mancini, G B John / Mayo, J / Abraham, A / White, J. ·Department of Medicine, University of Ottawa Heart Institute, Ontario, Canada. bchow@ottawaheart.ca ·Can J Cardiol · Pubmed #19279980.

ABSTRACT: -- No abstract --

5 Editorial Do the results of the SYNTAX trial apply to my centre? 2017

Le May, Michel / Wells, George A / Chong, Aun Yeong. ·University of Ottawa Heart Institute, Ottawa, Ontario, Canada. ·EuroIntervention · Pubmed #28930074.

ABSTRACT: -- No abstract --

6 Editorial Early Catheter Ablation for Unstable Ventricular Tachycardia: Still Too Early to Tell. 2017

Sapp, John L / Parkash, Ratika / Wells, George. ·From the QEII Health Sciences Centre, Halifax, NS, Canada (J.L.S., R.P.) · and University of Ottawa Heart Institute, ON, Canada (G.W.). ·Circ Arrhythm Electrophysiol · Pubmed #28292755.

ABSTRACT: -- No abstract --

7 Editorial Consideration of Native Coronary Disease Progression in the Decision to Perform Hybrid Coronary Revascularization. 2017

Rodriguez, Maria L / Glineur, David / Ruel, Marc. ·From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada. ·Innovations (Phila) · Pubmed #28085689.

ABSTRACT: -- No abstract --

8 Editorial The Sum of Its Parts: The Polygenic Basis of Coronary Artery Disease. 2016

McPherson, Ruth / Hegele, Robert A. ·Division of Cardiology, Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: rmcpherson@ottawaheart.ca. · Robarts Research Institute and Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. ·Can J Cardiol · Pubmed #27884482.

ABSTRACT: -- No abstract --

9 Editorial Meta-analysis of the messenger: The price of small trials diverting our attention from the real target. 2016

Rubens, Fraser. ·Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: frubens@ottawaheart.ca. ·J Thorac Cardiovasc Surg · Pubmed #26383003.

ABSTRACT: -- No abstract --

10 Editorial External stenting of vein grafts: Primum non nocere. 2015

Toeg, Hadi Daood / Boodhwani, Munir. ·Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: mboodhwani@ottawaheart.ca. ·J Thorac Cardiovasc Surg · Pubmed #26215355.

ABSTRACT: -- No abstract --

11 Editorial Impact of SPECT myocardial perfusion imaging on cardiac care. 2014

Lugomirski, Peter / Chow, Benjamin J W / Ruddy, Terrence D. ·Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. ·Expert Rev Cardiovasc Ther · Pubmed #25264155.

ABSTRACT: Single photon emission computed tomography myocardial perfusion imaging is a powerful modality for the assessment of coronary artery disease. It is useful in the diagnosis of CAD, prognostication of CAD and the determination of viability. It acts as guide for therapy and has the ability to assess effectiveness of therapy. The use of SPECT myocardial perfusion imaging has also been shown to be cost-effective compared to other modalities in cardiology.

12 Editorial Chromosome 9p21.3 locus for coronary artery disease: how little we know. 2013

McPherson, Ruth. ·Lipid Clinic and Atherogenomics Laboratory, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: rmcpherson@ottawaheart.ca. ·J Am Coll Cardiol · Pubmed #23933540.

ABSTRACT: -- No abstract --

13 Review Molecular imaging of coronary inflammation. 2019

Pelletier-Galarneau, Matthieu / Ruddy, Terrence D. ·Department of Radiology and Nuclear Medicine, Institut de cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada; Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, MA, USA. · Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada. Electronic address: truddy@ottawaheart.ca. ·Trends Cardiovasc Med · Pubmed #30195945.

ABSTRACT: Coronary inflammation is related to atherosclerotic disease and, less frequently, systemic vasculitis. Regardless of the etiology, coronary inflammation is associated with adverse cardiac events. Molecular imaging with

14 Review Coronary Surgery in Women and the Challenges We Face. 2018

Hessian, Renée / Jabagi, Habib / Ngu, Janet M C / Rubens, Fraser D. ·Divisions of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: fdrubens@ottawaheart.ca. ·Can J Cardiol · Pubmed #29571425.

ABSTRACT: This review was undertaken to understand the dynamics that have shaped our current treatment of women who undergo coronary artery bypass grafting (CABG) and summarize the current literature on surgical revascularization in women. There has been improved access to CABG over the past several decades. Despite this, compared with men, CABG in women involves fewer grafts and less frequent use of arterial grafts, the latter having improved long-term patency compared with saphenous vein grafts. We attempt to determine whether the adverse clinical profile of women, when referred for CABG is responsible for this finding. Female coronary anatomy and pathophysiology are reviewed and an attempt is made to understand how this might affect decisions of selection and outcome measures post CABG. We review the short-term, long-term, and quality of life outcomes in women. These data are taken from large databases, as well as from more recent publications. Randomized controlled trial data and meta-analytic data are used when available. Differential use of and outcomes of surgical strategies, including off-pump CABG and total arterial revascularization, are contrasted with those in men. This review shows that there continues to be widespread differences in surgical approach to coronary artery disease in female vs male patients. We provide evidence suggestive of the existence of issues specific to women that affect selection for surgical procedures and outcomes in women. More work is required to understand the reason for these differences and how to optimize sex-specific outcomes.

15 Review Role of plasminogen activator inhibitor-1 in coronary pathophysiology. 2018

Jung, Richard G / Simard, Trevor / Labinaz, Alisha / Ramirez, F Daniel / Di Santo, Pietro / Motazedian, Pouya / Rochman, Rebecca / Gaudet, Chantal / Faraz, Mohammad Ali / Beanlands, Rob S B / Hibbert, Benjamin. ·CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada. · CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. · CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: bhibbert@ottawaheart.ca. ·Thromb Res · Pubmed #29494856.

ABSTRACT: The standard of care for obstructive atherosclerotic coronary disease is revascularization, predominantly achieved via percutaneous placement of a stent with concurrent medical therapy. Advancements in percutaneous coronary intervention (PCI) have dramatically improved outcomes. However, major complications from PCI due to target lesion failure continue to occur at rates between 5 and 10% in the first twelve months following intervention limiting its therapeutic efficacy. Plasminogen activator inhibitor-1 (PAI-1) is a protein of interest for both arterial remodeling and thrombotic risk as it regulates cell migration and vascular thrombosis. Elevated PAI-1 antigen levels have been identified as a potential biomarker for coronary artery disease and metabolic syndrome while being modulated by a number of atherosclerotic risk factors. Although linked by some studies as a marker of disease severity and prognosis, it remains to be understood whether it is also a mediator and/or therapeutic target of vascular disease. In this review, we discuss the current understanding of PAI-1 in vascular disease and its potential role in in-stent restenosis and stent thrombosis.

16 Review 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy. 2018

Mehta, Shamir R / Bainey, Kevin R / Cantor, Warren J / Lordkipanidzé, Marie / Marquis-Gravel, Guillaume / Robinson, Simon D / Sibbald, Matthew / So, Derek Y / Wong, Graham C / Abunassar, Joseph G / Ackman, Margaret L / Bell, Alan D / Cartier, Raymond / Douketis, James D / Lawler, Patrick R / McMurtry, Michael S / Udell, Jacob A / van Diepen, Sean / Verma, Subodh / Mancini, G B John / Cairns, John A / Tanguay, Jean-François / Anonymous921134. ·McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: smehta@mcmaster.ca. · University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. · University of Toronto and Southlake Regional Health Centre, Toronto, Ontario, Canada. · Université de Montréal and Institut de Cardiologie de Montréal, Montréal, Quebec, Canada. · Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada. · McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. · University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada. · University of Toronto, Toronto, Ontario, Canada. · McMaster University and St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. · University of Toronto and Women's College Hospital and Peter Munk Cardiac Centre of Toronto General Hospital, Toronto, Ontario, Canada. · University of Toronto and St Michael's Hospital, Toronto, Ontario, Canada. · Université de Montréal and Institut de Cardiologie de Montréal, Montréal, Quebec, Canada. Electronic address: jean-francois.tanguay@icm-mhi.org. ·Can J Cardiol · Pubmed #29475527.

ABSTRACT: Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence. The present update to the 2011 and 2013 Canadian Cardiovascular Society APT guidelines incorporates new evidence on how to optimize APT use, particularly in situations in which few to no data were previously available. The recommendations update focuses on the following primary topics: (1) the duration of dual APT (DAPT) in patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome and non-acute coronary syndrome indications; (2) management of DAPT in patients who undergo noncardiac surgery; (3) management of DAPT in patients who undergo elective and semiurgent coronary artery bypass graft surgery; (4) when and how to switch between different oral antiplatelet therapies; and (5) management of antiplatelet and anticoagulant therapy in patients who undergo PCI. For PCI patients, we specifically analyze the particular considerations in patients with atrial fibrillation, mechanical or bioprosthetic valves (including transcatheter aortic valve replacement), venous thromboembolic disease, and established left ventricular thrombus or possible left ventricular thrombus with reduced ejection fraction after ST-segment elevation myocardial infarction. In addition to specific recommendations, we provide values and preferences and practical tips to aid the practicing clinician in the day to day use of these important agents.

17 Review Cardiac Computed Tomography: Before and After Cardiac Surgery. 2018

Erthal, Fernanda / Inacio, Joao R / Hazra, Samir / Chan, Vincent / Chow, Benjamin J W. ·Division of Cardiology. · Department of Radiology, The University of Ottawa, Ottawa, ON, Canada. · Division of Cardiac Surgery, University of Ottawa Heart Institute. ·J Thorac Imaging · Pubmed #28914744.

ABSTRACT: Cardiac computed tomography angiography (CCTA) is a noninvasive imaging technique that has been rapidly adopted into clinical practice. Over the past decade, technological advances have improved CCTA accuracy, and there is an increasing amount of data supporting its prognostic value in the assessment of coronary artery disease. Recently, "appropriate use criteria" has been used as a tool to minimize inappropriate testing and reduce patient exposure to unnecessary risk and inconclusive studies. This review will summarize the appropriate uses of CCTA in patients before and after cardiac surgery. Although the most common indication for CCTA is assessment of patency of native coronary arteries, other potential perioperative uses (eg, assessment of congenital heart disease, valvular heart disease, pericardial disease, myocardial disease, cardiac anatomy, bypass grafts, aortic disease, and cardiac masses) will be reviewed.

18 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.

19 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.

20 Review P2Y12 receptor inhibitor resistance and coronary artery disease: a bench to bedside primer for cardiovascular specialists. 2017

So, Derek Y F / Bagai, Akshay / Tran, Uyen / Verma, Subodh / Mehta, Shamir R. ·aUniversity of Ottawa Heart Institute, Ottawa bDivision of Cardiology cDivision of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto dPopulation Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. ·Curr Opin Cardiol · Pubmed #28661903.

ABSTRACT: PURPOSE OF REVIEW: Platelet P2Y12 receptor inhibitors are routinely prescribed for patients after acute coronary syndromes and percutaneous coronary interventions. Patients may have underresponsiveness (or resistance) to these drugs and in particular to clopidogrel, the most often used type. This review aims to focus on the concept of P2Y12 receptor inhibitor resistance and discuss incidence, mechanisms, novel diagnostic techniques and past and future clinical trials on the topic. RECENT FINDINGS: Patients treated with P2Y12 receptor inhibitors may develop high on-treatment platelet reactivity (HPR), a phenomenon of impaired response toward the drug, which has been associated with ischemic complications. Although potent P2Y12 inhibitors provide better ischemic protection, this must be balanced with increased bleeding risk. Several clinical factors, including common genetic variants such as Cytochrome P450 2C19 loss-of-function alleles, have been shown to predispose to HPR among patients on clopidogrel. Platelet function tests and genotyping platforms have enabled identification of patients at-risk for HPR. Past studies using platelet testing and tailoring therapy among patients with HPR have failed to provide conclusive data to support its routine use. SUMMARY: Ongoing studies using genotyping and novel antiplatelet regimens may identify potential strategies to minimize ischemic and bleeding risks concurrently. Until definitive studies demonstrate clear benefit of a personalized approach to P2Y12 inhibitor prescription, the choice of P2Y12 inhibitors should continue to be based on best evidence from previous large clinical trials.

21 Review Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography: A systematic review and meta-analysis. 2017

Ayoub, Chadi / Erthal, Fernanda / Abdelsalam, Mahmoud A / Murad, M Hassan / Wang, Zhen / Erwin, Patricia J / Hillis, Graham S / Kritharides, Leonard / Chow, Benjamin J W. ·Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; University of Sydney, New South Wales, Australia. Electronic address: ayoub.chadi@mayo.edu. · Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada. Electronic address: ferthal@ottawaheart.ca. · Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address: ma.abdelsalam.md@gmail.com. · Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. Electronic address: murad.mohammad@mayo.edu. · Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. Electronic address: wang.zhen@mayo.edu. · Mayo Clinic Libraries, Rochester, MN, USA. Electronic address: erwin.patricia@mayo.edu. · Department of Cardiology, Royal Perth Hospital, University of Western Australia, Australia. Electronic address: graham.hillis@health.wa.gov.au. · University of Sydney, New South Wales, Australia; Department of Cardiology, Concord Hospital, Sydney Local Health District, New South Wales, Australia. Electronic address: leonard.kritharides@sydney.edu.au. · Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada; Department of Radiology, University of Ottawa, Canada. Electronic address: bchow@ottawaheart.ca. ·J Cardiovasc Comput Tomogr · Pubmed #28483581.

ABSTRACT: BACKGROUND: The segment involvement score (SIS) is a semiquantitative measure of the extent of atherosclerosis burden by coronary computed tomography angiography (CTA). We sought to evaluate by meta-analysis the prognostic value of SIS, and to compare it with other CTA measures of coronary artery disease (CAD). METHODS: Electronic databases from 1946 to January 2016 were searched. Studies reporting SIS, or an equivalent measure by coronary CTA, and clinical outcomes were included. Maximally adjusted hazard ratios (HR), predominantly for clinical variables, were extracted for SIS, obstructive CAD, Agatston coronary artery calcium score, and plaque composition. These were pooled using DerSimonian-Laird random effects models. RESULTS: Eleven nonrandomized studies with good methodological quality enrolling 9777 subjects (mean age 61 ± 11 years, 57% male, mean follow up 3.3 years) who had 472 (4.8%) MACE (cardiac or all cause death, non-fatal myocardial infarction or late revascularization), were included. SIS (per segment increase) had pooled HR of 1.25 (95% CI: 1.16,1.35; I CONCLUSION: Despite heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary CTA is a strong, independent predictor of cardiovascular events.

22 Review New solid state cadmium-zinc-telluride technology for cardiac single photon emission computed tomographic myocardial perfusion imaging. 2017

Alenazy, Ali B / Wells, R Glenn / Ruddy, Terrence D. ·a Department of Medicine , University of Ottawa , Ottawa , Canada. · b Division of Cardiology , University of Ottawa Heart Institute , Ottawa , Canada. ·Expert Rev Med Devices · Pubmed #28276752.

ABSTRACT: INTRODUCTION: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is well established as diagnostic test for patients with suspected or known coronary artery disease. New camera systems have been developed with cadmium-zinc-telluride (CZT) detectors, novel collimator designs and reconstruction software. Areas covered: We review the current state of cardiac SPECT, advances in conventional camera technology and the development and clinical validation of solid-state CZT cameras. Expert commentary: The development of CZT systems is timely and addresses current issues for clinical SPECT imaging. These systems have a significant increase in photon sensitivity, permitting much lower radiation patient doses at a time when the lay and medical communities are very concerned about the radiation doses resulting from medical imaging. The increased count sensitivity permits shorter acquisition times and greater patient throughput which may address the ongoing and increasing issue of decreased funding for healthcare and, particularly, diagnostic imaging. The improved image resolution should improve diagnostic accuracy and increase the value of SPECT imaging for management of patients with CAD at a time of significant competition from other imaging modalities.

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 Using coronary calcification to exclude an ischemic etiology for cardiomyopathy: A validation study and systematic review. 2017

Premaratne, Manuja / Shamsaei, Mohabbat / Chow, Jonathan D H / Haddad, Tony / Erthal, Fernanda / Curran, Helen / Yam, Yeung / Szczotka, Agnieszka / Mielniczuk, Lisa / Wells, George A / Beanlands, Rob S / Hossain, Alomgir / Chow, Benjamin J W / Anonymous1770892. ·University of Ottawa Heart Institute, Division of Cardiology, Canada; Frankston Hospital, Department of Medicine, Frankston, Australia. · University of Ottawa Heart Institute, Division of Cardiology, Canada. · Dalhousie University and Queen Elizabeth II Health Sciences Center, Department of Medicine, Halifax, Canada. · University of Ottawa, Health Sciences Library, Canada. · University of Ottawa Heart Institute, Cardiovascular Research Methods Centre, Canada. · University of Ottawa Heart Institute, Division of Cardiology, Canada. Electronic address: bchow@ottawaheart.ca. ·Int J Cardiol · Pubmed #28041705.

ABSTRACT: BACKGROUND: Preliminary data suggests the absence of coronary artery calcification (CAC) excludes ischemic etiologies of cardiomyopathy. We prospectively validate and perform a systematic review to determine the utility of an Agatston score=0 to exclude the diagnosis of ischemic cardiomyopathy. METHODS AND RESULTS: Patients with newly diagnosed LV dysfunction were prospectively enrolled. Patients underwent CAC imaging and were followed until an etiologic diagnosis of cardiomyopathy was made. Eighty-two patients were enrolled in the study and underwent CAC imaging with 81.7% patients having non-ischemic cardiomyopathy. An Agatston score=0 successfully excluded an ischemic etiology for cardiomyopathy with a specificity of 100% (CI: 74.7-100%) and a positive predictive value of 100% (CI: 85.0%-100%). A systematic literature review was performed and studies were deemed suitable for inclusion if: 1) patients with CHF, cardiomyopathy or LV dysfunction were enrolled, 2) underwent CAC imaging and patients were assessed for an Agatston score=0 or the absence of CAC, and 3) the final etiologic diagnosis (ischemic or non-ischemic) was provided. Eight studies provided sufficient information to calculate operating characteristics for an Agatston score=0 and were combined with our validation cohort for a total of 754 patients. An Agatston score=0 excluded ischemic cardiomyopathy with specificity and positive predictive values of 98.4% (CI: 95.6-99.5%), and 98.3% (CI: 95.5-99.5%), respectively. CONCLUSIONS: In patients with cardiomyopathy of unknown etiology, an Agatston score=0 appears to rule out an ischemic etiology. A screening CAC may be a simple and cost-effective method of triaging patients, identifying those who do and do not need additional CAD investigations.

25 Review The Evolution of Coronary Bypass Surgery Will Determine Its Relevance as the Standard of Care for the Treatment for Multivessel Coronary Artery Disease. 2016

Glineur, David / Gaudino, Mario / Grau, Juan. ·From the Division of Cardiac Surgery, Ottawa Heart Institute, University of Ottawa, Canada (D.G.) · Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York (M.G.) · Department of Cardiac Surgery, Valley Heart and Vascular Institute, Ridgewood, NJ (J.G.) · and Division of Cardiothoracic Surgery, The University of Pennsylvania School of Medicine, Philadelphia (J.G.). ·Circulation · Pubmed #27777289.

ABSTRACT: -- No abstract --

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