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Coronary Artery Disease: HELP
Articles from University of Pennsylvania
Based on 174 articles published since 2008
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These are the 174 published articles about Coronary Artery Disease that originated from University of Pennsylvania during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Guideline Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors: US Preventive Services Task Force Recommendation Statement. 2018

Anonymous2681075 / Curry, Susan J / Krist, Alex H / Owens, Douglas K / Barry, Michael J / Caughey, Aaron B / Davidson, Karina W / Doubeni, Chyke A / Epling, John W / Kemper, Alex R / Kubik, Martha / Landefeld, C Seth / Mangione, Carol M / Silverstein, Michael / Simon, Melissa A / Tseng, Chien-Wen / Wong, John B. ·University of Iowa, Iowa City. · Fairfax Family Practice Residency, Fairfax, Virginia. · Virginia Commonwealth University, Richmond. · Veterans Affairs Palo Alto Health Care System, Palo Alto, California. · Stanford University, Stanford, California. · Harvard Medical School, Boston, Massachusetts. · Oregon Health & Science University, Portland. · Columbia University, New York, New York. · University of Pennsylvania, Philadelphia. · Virginia Tech Carilion School of Medicine, Roanoke. · Nationwide Children's Hospital, Columbus, Ohio. · Temple University, Philadelphia, Pennsylvania. · University of Alabama at Birmingham. · University of California, Los Angeles. · Boston University, Boston, Massachusetts. · Northwestern University, Evanston, Illinois. · University of Hawaii, Honolulu. · Pacific Health Research and Education Institute, Honolulu, Hawaii. · Tufts University, Medford, Massachusetts. ·JAMA · Pubmed #29998297.

ABSTRACT: Importance: Cardiovascular disease (CVD) is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by the Framingham Risk Score, the Pooled Cohort Equations, or similar CVD risk assessment models. If current CVD risk assessment models could be improved by adding more risk factors, treatment might be better targeted, thereby maximizing the benefits and minimizing the harms. Objective: To update the 2009 US Preventive Services Task Force (USPSTF) recommendation on using nontraditional risk factors in coronary heart disease risk assessment. Evidence Review: The USPSTF reviewed the evidence on using nontraditional risk factors in CVD risk assessment, focusing on the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score; the health benefits and harms of CVD risk assessment and treatment guided by nontraditional risk factors combined with the Framingham Risk Score or Pooled Cohort Equations compared with using either risk assessment model alone; and whether adding nontraditional risk factors to existing CVD risk assessment models improves measures of calibration, discrimination, and risk reclassification. Findings: The USPSTF found adequate evidence that adding the ABI, hsCRP level, and CAC score to existing CVD risk assessment models results in small improvements in discrimination and risk reclassification; however, the clinical meaning of these changes is largely unknown. Evidence on adding the ABI, hsCRP level, and CAC score to the Pooled Cohort Equations is limited. The USPSTF found inadequate evidence to assess whether treatment decisions guided by the ABI, hsCRP level, or CAC score, in addition to risk factors in existing CVD risk assessment models, leads to reduced incidence of CVD events or mortality. The USPSTF found adequate evidence to conceptually bound the harms of early detection and interventions as small. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the ABI, hsCRP level, or CAC score in risk assessment for CVD in asymptomatic adults to prevent CVD events. Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adding the ABI, hsCRP level, or CAC score to traditional risk assessment for CVD in asymptomatic adults to prevent CVD events. (I statement).

2 Guideline The Rationale for Performance of Coronary Angiography and Stenting Before Transcatheter Aortic Valve Replacement: From the Interventional Section Leadership Council of the American College of Cardiology. 2016

Ramee, Stephen / Anwaruddin, Saif / Kumar, Gautam / Piana, Robert N / Babaliaros, Vasilis / Rab, Tanveer / Klein, Lloyd W / Anonymous11460889 / Anonymous11470889. ·Ochsner Medical Center, New Orleans, Louisiana. · Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. · Emory University/Atlanta VA Medical Center, Atlanta, Georgia. · Vanderbilt University Medical Center, Nashville, Tennessee. · Emory University School of Medicine, Atlanta, Georgia. · Rush Medical College, Chicago, Illinois. Electronic address: lloydklein@comcast.net. ·JACC Cardiovasc Interv · Pubmed #27931592.

ABSTRACT: Transcatheter aortic valve replacement (TAVR) is an effective, nonsurgical treatment option for patients with severe aortic stenosis. The optimal treatment strategy for treating concomitant coronary artery disease (CAD) has not been tested prospectively in a randomized clinical trial. Nevertheless, it is standard practice in the United States to perform coronary angiography and percutaneous coronary intervention for significant CAD at least 1 month before TAVR. All existing clinical trials were designed using this strategy. Therefore, it is wrong to extrapolate current American College of Cardiology/American Heart Association Appropriate Use Criteria against invasive procedures in asymptomatic patients to the TAVR population when evaluating the quality of care by cardiologists or hospitals. In this statement from the Interventional Section Leadership Council of the ACC, it is recommended that percutaneous coronary intervention should be considered in all patients with significant proximal coronary stenosis in major coronary arteries before TAVR, even though the indication is not covered in current guidelines.

3 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 --

4 Editorial Intracoronary Imaging, Reverse Cholesterol Transport, and Transcriptomics: Precision Medicine in CAD? 2017

Chhatriwalla, Adnan K / Rader, Daniel J. ·Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: achhatriwalla@saint-lukes.org. · Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. ·J Am Coll Cardiol · Pubmed #28183507.

ABSTRACT: -- No abstract --

5 Editorial Coronary Bypass Surgery Versus Percutaneous Coronary Intervention in Left Main and Multivessel Disease: Incremental Data-How Do We Apply It? 2016

Hirshfeld, John W / Fiorilli, Paul N. ·Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: hirshfel@mail.med.upenn.edu. · Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. ·JACC Cardiovasc Interv · Pubmed #28007200.

ABSTRACT: -- No abstract --

6 Editorial SCAI position statement concerning coverage policies for percutaneous coronary interventions based on the appropriate use criteria. 2016

Klein, Lloyd W / Blankenship, James C / Kolansky, Daniel M / Dean, Larry S / Naidu, Srihari S / Chambers, Charles E / Duffy, Peter L / Anonymous2810861. ·Rush Medical College, Chicago, IL. · Geisinger Medical Center, Danville, PA. · University of Pennsylvania School of Medicine, Philadelphia, PA. · University of Washington, Seattle, WA. · Winthrop University Hospital, Mineola, NY. · Hershey Medical Center, Hershey, PA. · FirstHealth of the Carolinas, Reid Heart Center, Pinehurst, NC. ·Catheter Cardiovasc Interv · Pubmed #26968441.

ABSTRACT: -- No abstract --

7 Editorial Hybrid coronary revascularization: Ready for prime time, but who should star? 2016

Hiesinger, William / Atluri, Pavan. ·Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. · Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa. Electronic address: pavan.atluri@uphs.upenn.edu. ·J Thorac Cardiovasc Surg · Pubmed #26809426.

ABSTRACT: -- No abstract --

8 Editorial IRF2BP2: A New Player at the Crossroads of Inflammation and Lipid Metabolism. 2015

Zhang, Hanrui / Reilly, Muredach P. ·From the Department of Medicine, Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia. zhangha@mail.med.upenn.edu muredach@mail.med.upenn.edu. ·Circ Res · Pubmed #26405180.

ABSTRACT: -- No abstract --

9 Editorial Reducing the burden of disease and death from familial hypercholesterolemia: a call to action. 2014

Knowles, Joshua W / O'Brien, Emily C / Greendale, Karen / Wilemon, Katherine / Genest, Jacques / Sperling, Laurence S / Neal, William A / Rader, Daniel J / Khoury, Muin J. ·Stanford University School of Medicine and Cardiovascular Institute, Stanford, CA; The FH Foundation, South Pasadena, CA. · Duke Clinical Research Institute, Durham, NC. Electronic address: emily.obrien@duke.edu. · The FH Foundation, South Pasadena, CA. · McGill University, Montreal, Canada. · Emory University School of Medicine, Atlanta, GA. · West Virginia University, Morgantown, WV. · University of Pennsylvania, Philadelphia, PA. · Office of Public Health Genomics, Centers for Disease Control & Prevention, Atlanta, GA. ·Am Heart J · Pubmed #25458642.

ABSTRACT: Familial hypercholesterolemia (FH) is a genetic disease characterized by substantial elevations of low-density lipoprotein cholesterol, unrelated to diet or lifestyle. Untreated FH patients have 20 times the risk of developing coronary artery disease, compared with the general population. Estimates indicate that as many as 1 in 500 people of all ethnicities and 1 in 250 people of Northern European descent may have FH; nevertheless, the condition remains largely undiagnosed. In the United States alone, perhaps as little as 1% of FH patients have been diagnosed. Consequently, there are potentially millions of children and adults worldwide who are unaware that they have a life-threatening condition. In countries like the Netherlands, the United Kingdom, and Spain, cascade screening programs have led to dramatic improvements in FH case identification. Given that there are currently no systematic approaches in the United States to identify FH patients or affected relatives, the patient-centric nonprofit FH Foundation convened a national FH Summit in 2013, where participants issued a "call to action" to health care providers, professional organizations, public health programs, patient advocacy groups, and FH experts, in order to bring greater attention to this potentially deadly, but (with proper diagnosis) eminently treatable, condition.

10 Review Cardiac CT in the Emergency Department: Contrasting Evidence from Registries and Randomized Controlled Trials. 2018

Lee, Nam Ju / Litt, Harold. ·Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA. · Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA. Harold.litt@uphs.upenn.edu. ·Curr Cardiol Rep · Pubmed #29520449.

ABSTRACT: PURPOSE OF REVIEW: To compare outcomes between registries and randomized controlled trials of coronary computed tomographic angiography (CCTA)-based versus standard of care approaches to the initial evaluation of patients with acute chest pain. RECENT FINDINGS: Randomized trials have demonstrated CCTA to be a safe and efficient tool for triage of low- to intermediate-risk patients presenting to the emergency department with chest pain. Recent studies demonstrate heterogeneous result using different standard of care approaches for evaluation of hard endpoints in comparison with standard evaluation. Also, there has been continued concern for increase in subsequent testing after coronary CTA. Although CCTA improves detection of coronary artery disease, it is uncertain if it will bring improvement of long-term health outcomes at this point of time. Careful analysis of the previous results and further investigation will be required to validate evaluation of hard endpoints.

11 Review The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2017. 2018

Evans, Adam S / Weiner, Menachem / Patel, Prakash A / Baron, Elvera L / Gutsche, Jacob T / Jayaraman, Arun / Renew, J Ross / Martin, Archer K / Fritz, Ashley V / Gordon, Emily K / Riha, Hynek / Patel, Saumil / Ghadimi, Kamrouz / Guelaff, Eric / Feinman, Jared W / Dashell, Jillian / Munroe, Ray / Lauter, Derek / Weiss, Stuart J / Silvay, George / Augoustides, John G / Ramakrishna, Harish. ·Division of Cardiothoracic Anesthesiology, Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY. · Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Division of Cardiothoracic and Vascular Anesthesiology, Mayo Clinic, Scottsdale, AZ. · Division of Cardiothoracic Anesthesiology, Mayo Clinic, Jacksonville, FL. · Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. · Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC. · Cardiovascular and Thoracic Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: yiandoc@hotmail.com. ·J Cardiothorac Vasc Anesth · Pubmed #29174660.

ABSTRACT: -- No abstract --

12 Review Meta-analysis comparing radial versus femoral approach in patients 75 years and older undergoing percutaneous coronary procedures. 2017

Basu, Dev / Singh, Preet Mohinder / Tiwari, Anubhooti / Goudra, Basavana. ·Medstar Good Samaritan Hospital, Baltimore, MD, United States. Electronic address: devbasumd@gmail.com. · All India Institute of Medical Sciences, New Delhi, India. · Medstar Good Samaritan Hospital, Baltimore, MD, United States. · Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States. ·Indian Heart J · Pubmed #29054180.

ABSTRACT: INTRODUCTION: Elderly patients (≥75 years) undergoing coronary angioplasty are increasing. Meta-analyses have shown the benefits of radial access which might reduce hospital stay by decreasing access site complications with associated secondary benefits, however, the population over the age of 75 years were not a large part of the cohort and may behave differently due to increased atherosclerotic burden and age-related vascular changes. In addition, complications unique to this age group such as delirium and deconditioning might occur which could have a bearing on the outcome. METHODS: We searched Pubmed, SCOPUS, Medline, Dynamed, Cochrane. The search terms used were femoral and radial, femoral versus radial, radial or femoral access site, radial or femoral comparison. There were no restrictions. RESULTS: There was a significant decrease (85%)in the incidence of access site complications in the radial group. The time to achieve ambulation was lower by 14.25h (8.86-19.56h). However, the incidence of crossover (in effect failure to perform catheterization by radial access) from radial to femoral was significantly higher. Radial access was associated with longer procedural times (2.75min) and increased contrast dose however, there was no statistical difference in the fluoroscopy time between the two. CONCLUSIONS: Radial access has similar benefits in elderly patients as those under the age of 75 and may be beneficial in patients at risk of delirium or deconditioning. However, crossover rates, contrast dose and procedure time were higher. It is conceivable that as experience is gained, these rates will diminish.

13 Review Robotic-assisted percutaneous coronary intervention. 2017

Mangels, Daniel R / Giri, Jay / Hirshfeld, John / Wilensky, Robert L. ·Department of Medicine, University of Pennsylvania, 3400 Spruce Street, 100 Centrex, Philadelphia, Pennsylvania. · Division of Cardiovascular Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 11th Floor, South Pavilion, Philadelphia, Pennsylvania. ·Catheter Cardiovasc Interv · Pubmed #28722293.

ABSTRACT: Performance of percutaneous coronary intervention (PCI) is associated with several occupational hazards including radiation exposure and musculoskeletal injury. Current methods to mitigate these risks range from suspended radiation suits to adjustable lead-lined glass shields. Robotic-assisted PCI is a novel approach to PCI that utilizes remote-controlled technology to manipulate catheters thereby significantly reducing radiation exposure to the operator and catheterization laboratory staff. Although limited, current evidence indicates that robotic-assisted PCI is associated with a high technical success rate and may have additional advantages over conventional PCI, such as a decreased incidence of geographical miss. However, as the technology is nascent, further studies including larger, randomized controlled trials are needed to expand on the long-term clinical and safety outcomes.

14 Review Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta-Analysis. 2017

Kotronias, Rafail A / Kwok, Chun Shing / George, Sudhakar / Capodanno, Davide / Ludman, Peter F / Townend, Jonathan N / Doshi, Sagar N / Khogali, Saib S / Généreux, Philippe / Herrmann, Howard C / Mamas, Mamas A / Bagur, Rodrigo. ·Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom. · Oxford University Clinical Academic Graduate School, Oxford University, Oxford, United Kingdom. · The Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom. · Cardio-Thoracic-Vascular Department, Ferrarotto Hospital University of Catania, Italy. · Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. · The Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom. · Cardiovascular Research Foundation, New York, NY. · Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. · Morristown Medical Center, Morristown, NJ. · Cardiology Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. · Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom rodrigobagur@yahoo.com. · Division of Cardiology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada. · Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. ·J Am Heart Assoc · Pubmed #28655733.

ABSTRACT: BACKGROUND: Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta-analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation. METHODS AND RESULTS: We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random-effects meta-analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta-analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33-2.60; CONCLUSIONS: Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient-important clinical outcomes and may be associated with an increased risk of major vascular complications and 30-day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.

15 Review Risk of contrast-induced acute kidney injury in ST-elevation myocardial infarction patients undergoing multi-vessel intervention-meta-analysis of randomized trials and risk prediction modeling study using observational data. 2017

Chatterjee, Saurav / Kundu, Amartya / Mukherjee, Debabrata / Sardar, Partha / Mehran, Roxana / Bashir, Riyaz / Giri, Jay / Abbott, Jinnette D. ·Division of Cardiology, St. Luke's-Roosevelt Hospital Center of the Mount Sinai Health System, New York, New York. · Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. · Division of Cardiology, Texas Tech University Health Sciences Center, El Paso, Texas. · Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah. · Director of Interventional Research, Icahn School of Medicine, Mount Sinai Health System, New York, New York. · Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania. · Penn Cardiovascular Outcomes, Quality & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. · Warren Alpert School of Medicine and Brown University, Rhode Island Hospital, Providence, Rhode Island. ·Catheter Cardiovasc Interv · Pubmed #28112470.

ABSTRACT: OBJECTIVES: Ascertaining risk of contrast induced acute kidney injury (CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients undergoing multi-vessel percutaneous coronary intervention (MV-PCI). BACKGROUND: Complete revascularization may improve outcomes in STEMI patients with multi-vessel disease. However, a practice of MV-PCI may be associated with a higher risk of CI-AKI. We aimed to evaluate the risk of CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a validated risk score. METHODS: We searched PubMed, Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI and infarct-related artery (IRA) only PCI during index hospitalization. A random effects model was used to estimate the risk ratio (RR) and respective 95% confidence intervals (CI). We queried the Nationwide Inpatient Sample (NIS) to assess the ability of the Mehran risk score to accurately predict the incidence of CI-AKI in patients undergoing MV-PCI. RESULTS: Four randomized studies (N = 1,602) were included in the final analysis. The risk of CI-AKI was low and no difference was observed with MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57; P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI for STEMI patients in the NIS. The Mehran risk score accurately discriminated 78% of the patients who developed CI-AKI in this cohort (c-statistic of 0.78, P = 0.002). CONCLUSIONS: MV-PCI in STEMI is not associated with a higher risk of CI-AKI and the Mehran risk score can identify patients at higher risk for this complication. © 2017 Wiley Periodicals, Inc.

16 Review Bioresorbable Scaffolds for Coronary Artery Disease. 2017

Nathan, Ashwin / Kobayashi, Taisei / Kolansky, Daniel M / Wilensky, Robert L / Giri, Jay. ·Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Perelman Center, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA. · Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA. · Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Perelman Center, South Tower, 11th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA. Jay.Giri@uphs.upenn.edu. · Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA. Jay.Giri@uphs.upenn.edu. ·Curr Cardiol Rep · Pubmed #28108898.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this review is to present an overview of the recent evidence regarding the use of bioresorbable scaffolds in percutaneous coronary intervention. RECENT FINDINGS: Bioresorbable scaffolds represent a potentially unique engineering solution to the problems associated with metallic stents. The Absorb everolimus-eluting bioresorbable scaffold has been the most extensively tested of this class and is currently Food and Drug Administration-approved for use in the USA. While early studies suggested that it has comparable overall efficacy as compared to drug-eluting metallic stents, they also demonstrated a significantly increased risk of stent thrombosis. Bioresorbable scaffolds may be comparable to drug-eluting stents, though associated with an increased risk of stent thrombosis. They are a nascent technology with several competitive product designs in development and continued iterative technological improvements are expected over the next several years.

17 Review Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease. 2017

Naqvi, Syed Yaseen / Klein, Jordan / Saha, Tisa / McCormick, Daniel J / Goldberg, Sheldon. ·Department of Internal Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania. · Department of Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania. · Department of Cardiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania. Electronic address: sheldongoldberg66@gmail.com. ·Am J Cardiol · Pubmed #28012553.

ABSTRACT: Coronary artery bypass grafting (CABG) decreases mortality in patients with significant left main (LM) coronary artery disease and for years remained the therapy of choice for patients with this ominous lesion. Advances in percutaneous coronary intervention (PCI) have enabled it to become an alternative to CABG. The results of observational registries and randomized comparisons have shown the safety and efficacy of PCI in appropriately selected patients with low or intermediate angiographic risk scores. Furthermore, the use of physiological measures of flow limitation and the use of intracoronary imaging techniques has added benefit and improved outcomes. The use of fractional flow reserve to more accurately evaluate the significance of intermediate lesions and guide the extent of revascularization has been an important refinement. Intravascular ultrasound and optical coherence tomography assessment of optimal stent deployment has led to reductions in restenosis. Newer generation stents, combined with improvements in specific techniques, especially at the LM bifurcation have extended PCI to more complex anatomic scenarios. The availability of left ventricular support devices in patients with complex coronary anatomy and severely depressed left ventricular function has added a margin of safety to LM and multivessel intervention. Randomized comparisons of CABG with PCI in carefully selected patients, using contemporaneous surgical and interventional techniques and optimal medical therapy, will further aid heart teams in the decision-making process. In conclusion, this review will give a concise overview of the management of unprotected LM disease.

18 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 --

19 Review Cholesterol efflux capacity of high-density lipoprotein correlates with survival and allograft vasculopathy in cardiac transplant recipients. 2016

Javaheri, Ali / Molina, Maria / Zamani, Payman / Rodrigues, Amrith / Novak, Eric / Chambers, Susan / Stutman, Patricia / Maslanek, Wilhelmina / Williams, Mary / Lilly, Scott M / Heeger, Peter / Sayegh, Mohamed H / Chandraker, Anil / Briscoe, David M / Daly, Kevin P / Starling, Randall / Ikle, David / Christie, Jason / Rame, J Eduardo / Goldberg, Lee R / Billheimer, Jeffrey / Rader, Daniel J. ·Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA. Electronic address: ali.javaheri@wustl.edu. · Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA. · Division of Cardiology, Ohio State University, Columbus, Ohio, USA. · Icahn School of Medicine at Mount Sinai, New York, New York. · Brigham & Women׳s Hospital, Harvard University, Boston, Massachusetts, USA; Department of Medicine and Immunology, American University of Beirut, Beirut, Lebanon. · Brigham & Women׳s Hospital, Harvard University, Boston, Massachusetts, USA. · Children's Hospital Boston, Boston, Massachusetts, USA. · Cleveland Clinic, Cleveland, Ohio, USA. · Department of Biostatistics, Rho Federal Systems Division, Rho, Inc., Chapel Hill, North Carolina, USA. ·J Heart Lung Transplant · Pubmed #27498384.

ABSTRACT: BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major cause of mortality after cardiac transplantation. High-density lipoprotein (HDL) cholesterol efflux capacity (CEC) is inversely associated with coronary artery disease. In 2 independent studies, we tested the hypothesis that reduced CEC is associated with mortality and disease progression in CAV. METHODS: We tested the relationship between CEC and survival in a cohort of patients with CAV (n = 35). To determine whether reduced CEC is associated with CAV progression, we utilized samples from the Clinical Trials in Organ Transplantation 05 (CTOT05) study to determine the association between CEC and CAV progression and status at 1 year (n = 81), as assessed by average change in maximal intimal thickness (MIT) on intravascular ultrasound. RESULTS: Multivariable Cox proportional hazard models demonstrated that higher levels of CEC were associated with improved survival (hazard ratio 0.26, 95% confidence interval 0.11 to 0.63) per standard deviation CEC, p = 0.002). Patients who developed CAV had reduced CEC at baseline and 1-year post-transplant. We observed a significant association between pre-transplant CEC and the average change in MIT, particularly among patients who developed CAV at 1 year (β = -0.59, p = 0.02, R CONCLUSION: Reduced CEC is associated with disease progression and mortality in CAV patients. These findings suggest the hypothesis that interventions to increase CEC may be useful in cardiac transplant patients for prevention or treatment of CAV.

20 Review Acquired and Congenital Coronary Artery Diseases. 2016

Fuller, Stephanie / Ravishankar, Chitra. ·1Division of Cardiothoracic Surgery, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Pediatrics, Section of Cardiology, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA. ·Pediatr Crit Care Med · Pubmed #27490623.

ABSTRACT: OBJECTIVES: The objectives of this review are to discuss the spectrum of coronary artery anomalies and the evidence behind current treatment strategies. DATA SOURCE: MEDLINE and PubMed. CONCLUSION: Coronary artery anomalies exist in up to 1% of the population and most of these do not cause symptoms or ischemia and do not require any surgical intervention whereas others are potentially fatal. The type of surgical intervention is often dictated by the type of lesion, and upon the unique anatomic and physiologic variables associated with each lesion. Postoperative care can be challenging particularly after surgical repair of anomalous left coronary artery from the pulmonary artery.

21 Review Targeting ApoC-III to Reduce Coronary Disease Risk. 2016

Khetarpal, Sumeet A / Qamar, Arman / Millar, John S / Rader, Daniel J. ·Perelman School of Medicine, University of Pennsylvania, 11-125 SCTR, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. · Perelman School of Medicine, University of Pennsylvania, 11-125 SCTR, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA. rader@mail.med.upenn.edu. ·Curr Atheroscler Rep · Pubmed #27443326.

ABSTRACT: Triglyceride-rich lipoproteins (TRLs) are causal contributors to the risk of developing coronary artery disease (CAD). Apolipoprotein C-III (apoC-III) is a component of TRLs that elevates plasma triglycerides (TGs) through delaying the lipolysis of TGs and the catabolism of TRL remnants. Recent human genetics approaches have shown that heterozygous loss-of-function mutations in APOC3, the gene encoding apoC-III, lower plasma TGs and protect from CAD. This observation has spawned new interest in therapeutic efforts to target apoC-III. Here, we briefly review both currently available as well as developing therapies for reducing apoC-III levels and function to lower TGs and cardiovascular risk. These therapies include existing options including statins, fibrates, thiazolidinediones, omega-3-fatty acids, and niacin, as well as an antisense oligonucleotide targeting APOC3 currently in clinical development. We review the mechanisms of action by which these drugs reduce apoC-III and the current understanding of how reduction in apoC-III may impact CAD risk.

22 Review Cardiovascular Disease Risk Associated With Familial Hypercholesterolemia: A Systematic Review of the Literature. 2016

Wong, Bruce / Kruse, Gregory / Kutikova, Lucie / Ray, Kausik K / Mata, Pedro / Bruckert, Eric. ·Centre for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: brucejowong@gmail.com. · The Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania. · Amgen (Europe) GmbH, Zug, Switzerland. · Imperial College London, London, United Kingdom. · Fundación Hipercoesterolaemia Familiar, Madrid, Spain. · Hôpital Pitié Salpêtrière, Paris, France. ·Clin Ther · Pubmed #27261205.

ABSTRACT: PURPOSE: The goal of this study was to determine cardiovascular disease (CVD) risk associated with familial hypercholesterolemia (FH). METHODS: A systematic review of the published literature was conducted. All publications describing FH risk from PubMed ("cardiovascular disease risk + familial hypercholesterolaemia," 2004-2015), Internet and Medline search of FH registries, and associated references were screened for FH-related CVD risk in titles, abstracts, and study methods. CVD risk expressed as rates, odds, or ratios of mortality and morbidity were extracted. Each article was reviewed for bias by 2 reviewers within 17 items in 7 categories; a modified Newcastle-Ottawa assessment scale was used for nonrandomized studies. FINDINGS: The complete literature search identified 712 potential publications: 549 from PubMed (Medline), 150 from registries, and 13 from references. Fourteen articles met the inclusion criteria: 8 from registries in the United Kingdom, the Netherlands, Norway, and Spain; 5 from single hospitals or families in Japan, Denmark, the Netherlands, and the United Kingdom; and a population survey in Denmark. Across studies, attrition bias was low in 22 (80%) of 28 items. Risk of selection bias was high in 35 (63%) of 56 items. Selection bias risk was due to low representativeness and lack of a non-FH comparator group within the same study; detection bias risk was due to variable definitions of CVD outcomes/measurement; and performance bias risk was due to long-term, intensive treatment, the most common limitations for registries. Studies from single hospitals and families lacked generalizability. In contrast, the Danish study revealed a low bias in each of the 4 selection bias criteria and 2 attrition risk criteria. Fatal and nonfatal CVD events were collected in the study. Comparing patients with FH versus non-FH patients, the odds ratios for coronary artery disease were 10.3 (95% CI, 7.8-13.8) and 13.2 (95% CI, 10.0-17.4) in subjects treated and not treated with lipid-lowering therapy, respectively. These ratios fall within the ranges of ratios reported in other studies but are generally higher than the ratios from registries and clinics, in which intensive specialized management is available. IMPLICATIONS: There is a lack of available data describing CVD risk in patients with FH, and many of the existing studies have biases in their design that could affect their risk estimates. A Danish study had the highest quality based on a predefined quality check list, providing the most credible estimates of the increase in CVD risk in patients with FH. The CVD risk due to FH is high and represents unmet medical need for patients with FH. Further research is warranted to validate the magnitude of risk.

23 Review Therapeutic Targets of Triglyceride Metabolism as Informed by Human Genetics. 2016

Bauer, Robert C / Khetarpal, Sumeet A / Hand, Nicholas J / Rader, Daniel J. ·Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104-5159, USA. · Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104-5159, USA. Electronic address: rader@mail.med.upenn.edu. ·Trends Mol Med · Pubmed #26988439.

ABSTRACT: Human genetics has contributed to the development of multiple drugs to treat hyperlipidemia and coronary artery disease (CAD), most recently including antibodies targeting PCSK9 to reduce LDL cholesterol. Despite these successes, a large burden of CAD remains. Genetic and epidemiological studies have suggested that circulating triglyceride (TG)-rich lipoproteins (TRLs) are a causal risk factor for CAD, presenting an opportunity for novel therapeutic strategies. We discuss recent unbiased human genetics testing, including genome-wide association studies (GWAS) and whole-genome or -exome sequencing, that have identified the lipoprotein lipase (LPL) and hepatic lipogenesis pathways as important mechanisms in the regulation of circulating TRLs. Further strengthening the causal relationship between TRLs and CAD, findings such as these may provide novel targets for much-needed potential therapeutic interventions.

24 Review From Loci to Biology: Functional Genomics of Genome-Wide Association for Coronary Disease. 2016

Nurnberg, Sylvia T / Zhang, Hanrui / Hand, Nicholas J / Bauer, Robert C / Saleheen, Danish / Reilly, Muredach P / Rader, Daniel J. ·From the Division of Translational Medicine and Human Genetics, Department of Medicine (S.T.N., R.C.B., D.J.R.), Penn Cardiovascular Institute, Department of Medicine (H.Z., M.P.R., D.J.R.), Department of Genetics (N.J.H., D.J.R.), and Department of Biostatistics and Epidemiology (D.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia. · From the Division of Translational Medicine and Human Genetics, Department of Medicine (S.T.N., R.C.B., D.J.R.), Penn Cardiovascular Institute, Department of Medicine (H.Z., M.P.R., D.J.R.), Department of Genetics (N.J.H., D.J.R.), and Department of Biostatistics and Epidemiology (D.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia. mpr2144@cumc.columbia.edu rader@upenn.edu. ·Circ Res · Pubmed #26892960.

ABSTRACT: Genome-wide association studies have provided a rich collection of ≈ 58 coronary artery disease (CAD) loci that suggest the existence of previously unsuspected new biology relevant to atherosclerosis. However, these studies only identify genomic loci associated with CAD, and many questions remain even after a genomic locus is definitively implicated, including the nature of the causal variant(s) and the causal gene(s), as well as the directionality of effect. There are several tools that can be used for investigation of the functional genomics of these loci, and progress has been made on a limited number of novel CAD loci. New biology regarding atherosclerosis and CAD will be learned through the functional genomics of these loci, and the hope is that at least some of these new pathways relevant to CAD pathogenesis will yield new therapeutic targets for the prevention and treatment of CAD.

25 Review How to Approach the Assessment of Cardiac Allograft Vasculopathy in the Modern Era: Review of Invasive Imaging Modalities. 2016

Javaheri, Ali / Saha, Naveen / Lilly, Scott M. ·University of Pennsylvania School of Medicine, Philadelphia, PA, USA. · Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA. · Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, USA. scott.lilly@osumc.edu. ·Curr Heart Fail Rep · Pubmed #26879390.

ABSTRACT: Heart transplantation is one of the most definitive therapies for end-stage heart failure. The therapy is unfortunately marred by the devastating complications of cardiac allograft vasculopathy (CAV). Non-invasive screening and assessment for CAV has been greatly limited by both low sensitivity and poor correlation with adverse outcomes. As such, invasive imaging with coronary angiography has emerged as the gold standard for detection of CAV. Although conventional coronary angiography serves well for larger lesions, the modality has been significantly enhanced with adjunct imaging to visualize the intimal hyperplasia that is a hallmark of the disease process. These modalities include intravascular ultrasound (IVUS) and optical coherence tomography (OCT). In the following review, we summarize both the invasive and non-invasive assessments of CAV. We further conclude that the current evidence poorly supports the use of non-invasive testing for early CAV and that a transition should be considered to routine early angiography with adjunctive intravascular imaging.

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