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Coronary Artery Disease: HELP
Articles from West Midlands
Based on 103 articles published since 2008
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These are the 103 published articles about Coronary Artery Disease that originated from West Midlands during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial Resolute zotarolimus eluting stent for treatment of long coronary lesions. 2015

Rothman, Martin. ·Chief Medical Officer & Vice President, Medical Affairs, Coronary, Structural Heart and Renal Denervation, Medtronic, Inc., Santa Rosa, CA, USA; Professor of Interventional Cardiology, Bart's Health NHS Trust, London, England, UK. Electronic address: martin.t.rothman@medtronic.com. ·Indian Heart J · Pubmed #26138172.

ABSTRACT: -- No abstract --

2 Editorial A reliable marker of vascular function: Does it exist? 2015

Blann, Andrew D. ·University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. Electronic address: a.blann@bham.ac.uk. ·Trends Cardiovasc Med · Pubmed #25861960.

ABSTRACT: -- No abstract --

3 Editorial Modern management of atrial fibrillation requires initial identification of "low-risk" patients using the CHA2DS2-VASc score, and not focusing on "high-risk" prediction. 2014

Lip, Gregory Yh / Lane, Deirdre A. ·University of Birmingham Centre for Cardiovascular Sciences, City Hospital. ·Circ J · Pubmed #25008366.

ABSTRACT: -- No abstract --

4 Editorial Time to take periodontitis seriously. 2014

Chapple, Iain L C. ·University of Birmingham Periodontal Research Group and MRC Centre for Immune Regulation, Dental School, Birmingham B4 6NN, UK. ·BMJ · Pubmed #24721751.

ABSTRACT: -- No abstract --

5 Review Amiodarone-Induced Thyroid Dysfunction: A Clinical Update. 2018

Elnaggar, Mohamed Nabil / Jbeili, Kahtan / Nik-Hussin, Nik / Kozhippally, Mohandas / Pappachan, Joseph M. ·Department of Endocrinology, Diabetes & Metabolism, University Hospitals of Morecambe Bay NHS Foundation Trust, United Kingdom, LA1 4RP. · Internal Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt. · Department of Radiology and Nuclear Imaging Services, University Hospitals of Morecambe Bay NHS Foundation Trust, United Kingdom, LA1 4RP. · Department of Medicine, Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, United Kingdom, B75 7RR. ·Exp Clin Endocrinol Diabetes · Pubmed #29558786.

ABSTRACT: Amiodarone is one of the most commonly prescribed antiarrhythmic agents in clinical practice owing to its efficacy, even with high toxicity profile. The high iodine content and the prolonged biological half-life of the drug can result in thyroid dysfunction in a high proportion of patients treated with amiodarone even after cessation of amiodarone. Both hypothyroidism and hyperthyroidism are common side effects that mandate regular monitoring of patients with thyroid function tests. Amiodarone-induced hypothyroidism (AIH) is diagnosed and managed in the same way as a usual case of hypothyroidism. However, differential diagnosis and clinical management of amiodarone-induced thyrotoxicosis (AIT) subtypes can be challenging. With the aid of a case snippet, we update the current evidence for the diagnostic work up and management of patients with amiodarone-induced thyroid dysfunction in this article.

6 Review Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence. 2018

Powell, Richard / McGregor, Gordon / Ennis, Stuart / Kimani, Peter K / Underwood, Martin. ·Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK. · Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK. · Faculty of Health and Life Sciences, Coventry University, Coventry, UK. · Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK. · Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK. ·BMJ Open · Pubmed #29540415.

ABSTRACT: OBJECTIVES: To determine the contemporary effectiveness of exercise-based cardiac rehabilitation (CR) in terms of all-cause mortality, cardiovascular mortality and hospital admissions. DATA SOURCES: Studies included in or meeting the entry criteria for the 2016 Cochrane review of exercise-based CR in patients with coronary artery disease. STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) of exercise-based CR versus a no-exercise control whose participants were recruited after the year 2000. STUDY APPRAISAL AND SYNTHESIS METHODS: Two separate reviewers independently screened the characteristics of studies. One reviewer quality appraised any new studies and assessed their risk of bias using the Cochrane Collaboration's recommended risk of bias tool. Data were reported as the risk difference (95% CI). RESULTS: We included 22 studies with 4834 participants (mean age 59.5 years, 78.4% male). We found no differences in outcomes between exercise-based CR and a no-exercise control at their longest follow-up period for: all-cause mortality (19 studies; n=4194; risk difference 0.00, 95% CI -0.02 to 0.01, P=0.38) or cardiovascular mortality (9 studies; n=1182; risk difference -0.01, 95% CI -0.02 to 0.01, P=0.25). We found a small reduction in hospital admissions of borderline statistical significance (11 studies; n=1768; risk difference -0.05, 95% CI -0.10 to -0.00, P=0.05). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Our analysis indicates conclusively that the current approach to exercise-based CR has no effect on all-cause mortality or cardiovascular mortality, when compared with a no-exercise control. There may be a small reduction in hospital admissions following exercise-based CR that is unlikely to be clinically important. PROSPERO REGISTRATION NUMBER: CRD42017073616.

7 Review Premature coronary artery disease and early stage chronic kidney disease. 2018

Price, A M / Ferro, C J / Hayer, M K / Steeds, R P / Edwards, N C / Townend, J N. ·Department of Nephrology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK. · Department of Cardiology, Birmingham Cardio-Renal Group, Institute of Cardiovascular Science, Queen Elizabeth Hospital Birmingham and University of Birmingham, Edgbaston, UK. ·QJM · Pubmed #29024966.

ABSTRACT: A 30 year old asymptomatic male with stage 3 chronic kidney disease (CKD) secondary to Focal Segmental Glomerulosclerosis was found to have features of CKD associated cardiomyopathy including left ventricular hypertrophy (LVH) and focal sub-endocardial scarring on cardiac magnetic resonance imaging. There was also a significantly raised CT coronary calcium score and evidence of non-flow limiting coronary artery disease (CAD) on a CT coronary angiogram. Early stage CKD is a major risk factor for cardiovascular risk causing myocardial hypertrophy and fibrosis and coronary artery atheroma. Cardiovascular risk begins to increase from an eGFR of around 75ml/min/1.73m2. The pathophysiology of cardiovascular disease in CKD is under investigation but to date, treatment options are limited. Blood pressure control and statins have the strongest supportive evidence.

8 Review The effects of particle size, shape, density and flow characteristics on particle margination to vascular walls in cardiovascular diseases. 2018

Ta, Hang T / Truong, Nghia P / Whittaker, Andrew K / Davis, Thomas P / Peter, Karlheinz. ·a Australian Institute for Bioengineering and Nanotechnology , University of Queensland , Brisbane , Australia. · b ARC Centre of Excellence in Convergent Bio-Nano Science and Technology , Australia. · c Monash Institute of Pharmaceutical Sciences , Monash University, Parkville , Melbourne , Victoria , Australia. · d Department of Chemistry , University of Warwick , Coventry , UK. · e Atherothrombosis and Vascular Laboratory , Baker IDI Heart and Diabetes Institute , Melbourne , Australia. · f Department of Medicine , Monash University , Melbourne , Australia. ·Expert Opin Drug Deliv · Pubmed #28388248.

ABSTRACT: INTRODUCTION: Vascular-targeted drug delivery is a promising approach for the treatment of atherosclerosis, due to the vast involvement of endothelium in the initiation and growth of plaque, a characteristic of atherosclerosis. One of the major challenges in carrier design for targeting cardiovascular diseases (CVD) is that carriers must be able to navigate the circulation system and efficiently marginate to the endothelium in order to interact with the target receptors. Areas covered: This review draws on studies that have focused on the role of particle size, shape, and density (along with flow hemodynamics and hemorheology) on the localization of the particles to activated endothelial cell surfaces and vascular walls under different flow conditions, especially those relevant to atherosclerosis. Expert opinion: Generally, the size, shape, and density of a particle affect its adhesion to vascular walls synergistically, and these three factors should be considered simultaneously when designing an optimal carrier for targeting CVD. Available preliminary data should encourage more studies to be conducted to investigate the use of nano-constructs, characterized by a sub-micrometer size, a non-spherical shape, and a high material density to maximize vascular wall margination and minimize capillary entrapment, as carriers for targeting CVD.

9 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.

10 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.

11 Review Current Understanding of Atherogenesis. 2017

Brown, Richard A / Shantsila, Eduard / Varma, Chetan / Lip, Gregory Y H. ·Department of Medicine, University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom. · Department of Medicine, University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom; Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital and Sandwell Hospital, West Bromwich, United Kingdom. · Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital and Sandwell Hospital, West Bromwich, United Kingdom. · Department of Medicine, University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom; Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital and Sandwell Hospital, West Bromwich, United Kingdom. Electronic address: g.y.h.lip@bham.ac.uk. ·Am J Med · Pubmed #27888053.

ABSTRACT: Scientific understanding of atherogenesis is constantly developing. From Virchow's observations 160 years ago we now recognize the endothelial response to injury as inflammatory, involved in all stages of atherosclerosis. Endothelial activation may cause reversible injury or dysfunction, or lead to irreparable damage. Indeed, early atherosclerosis is reversible. The introduction of genome-wide association testing has furthered the identification of potentially important genetic variants that help explain the heritability of coronary artery disease as well as spontaneous cases of severe coronary artery disease in patients with otherwise minimal risk factors. However, the mechanisms by which many of the newer variants exert their influence remain unknown.

12 Review Antiplatelet and Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Coronary Stenting. 2017

Dzeshka, Mikhail S / Brown, Richard A / Capodanno, Davide / Lip, Gregory Y H. ·University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK; Department of Internal Medicine I, Grodno State Medical University, Gorkogo 80, Grodno 230009, Belarus. · University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK. · Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli 6, CT 95124, Italy. · University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK; Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg Hospital Science and Innovation Center, Søndre Skovvej 15, Aalborg 9100, Denmark. Electronic address: g.y.h.lip@bham.ac.uk. ·Interv Cardiol Clin · Pubmed #27886825.

ABSTRACT: Stroke prevention is the main priority in the management cascade of atrial fibrillation. Most patients require long-term oral anticoagulation (OAC) and may require percutaneous coronary intervention. Prevention of recurrent cardiac ischemia and stent thrombosis necessitate dual antiplatelet therapy (DAPT) for up to 12 months. Triple antithrombotic therapy with OAC plus DAPT of shortest feasible duration is warranted, followed by dual antithrombotic therapy of OAC and antiplatelet agent, and OAC alone after 12 months. Because of elevated risk of hemorrhagic complications, new-generation drug-eluting stents, lower-intensity OAC, radial access, and routine use of gastric protection with proton pump inhibitors are recommended.

13 Review Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1. 2017

Diener, Hans-Christoph / Aisenberg, James / Ansell, Jack / Atar, Dan / Breithardt, Günter / Eikelboom, John / Ezekowitz, Michael D / Granger, Christopher B / Halperin, Jonathan L / Hohnloser, Stefan H / Hylek, Elaine M / Kirchhof, Paulus / Lane, Deirdre A / Verheugt, Freek W A / Veltkamp, Roland / Lip, Gregory Y H. ·Department of Neurology, University Hospital Essen, Essen, Germany. · Icahn School of Medicine at Mount Sinai, New York, USA. · Hofstra North Shore/LIJ School of Medicine, Hempstead, USA. · Division of Medicine, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway. · Division of Rhythmology, Department of Cardiovascular Medicine, Hospital of the University Münster, Münster, Germany. · Population Health Research Institute, McMaster University, Hamilton, ON, Canada. · Cardiovascular Research Foundation, New York, NY, USA. · Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA. · Lankenau Medical Center, Wynnewood, PA, USA. · Department of Medicine, Duke University, Durham, NC, USA. · Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, New York, NY, USA. · Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany. · Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. · Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK. · Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany. · University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK. · Afdeling Cardiologie, Hartcentrum OLVG, Amsterdam, The Netherlands. · Stroke Medicine, Imperial College London, London, UK. · University of Birmingham, Birmingham, UK. · Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. ·Eur Heart J · Pubmed #26848149.

ABSTRACT: Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation.

14 Review Impact of Incomplete Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease: A Systematic Review and Meta-Analysis. 2016

Nagaraja, Vinayak / Ooi, Sze-Yuan / Nolan, James / Large, Adrian / De Belder, Mark / Ludman, Peter / Bagur, Rodrigo / Curzen, Nick / Matsukage, Takashi / Yoshimachi, Fuminobu / Kwok, Chun Shing / Berry, Colin / Mamas, Mamas A. ·Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia. · Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. · Keele Cardiovascular Research Group, Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, United Kingdom. · The James Cook University Hospital, Middlesbrough, United Kingdom. · Queen Elizabeth Hospital, Birmingham, United Kingdom. · Division of Cardiology, Department of Medicine and Department of Epidemiology & Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada. · University Hospital Southampton & Faculty of Medicine University of Southampton, United Kingdom. · Division of Cardiology, Tokai University School of Medicine, Isehara, Japan. · Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom. · Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom mamasmamas1@yahoo.co.uk. ·J Am Heart Assoc · Pubmed #27986755.

ABSTRACT: BACKGROUND: Up to half of patients undergoing percutaneous coronary intervention have multivessel coronary artery disease (MVD) with conflicting data regarding optimal revascularization strategy in such patients. This paper assesses the evidence for complete revascularization (CR) versus incomplete revascularization in patients undergoing percutaneous coronary intervention, and its prognostic impact using meta-analysis. METHODS AND RESULTS: A search of PubMed, EMBASE, MEDLINE, Current Contents Connect, Google Scholar, Cochrane library, Science Direct, and Web of Science was conducted to identify the association of CR in patients with multivessel coronary artery disease undergoing percutaneous coronary intervention with major adverse cardiac events and mortality. Random-effects meta-analysis was used to estimate the odds of adverse outcomes. Meta-regression analysis was conducted to assess the relationship with continuous variables and outcomes. Thirty-eight publications that included 156 240 patients were identified. Odds of death (OR 0.69, 95% CI 0.61-0.78), repeat revascularization (OR 0.60, 95% CI 0.45-0.80), myocardial infarction (OR 0.64, 95% CI 0.50-0.81), and major adverse cardiac events (OR 0.63, 95% CI 0.50-0.79) were significantly lower in the patients who underwent CR. These outcomes were unchanged on subgroup analysis regardless of the definition of CR. Similar findings were recorded when CR was studied in the chronic total occlusion (CTO) subgroup (OR 0.65, 95% CI 0.53-0.80). A meta-regression analysis revealed a negative relationship between the OR for mortality and the percentage of CR. CONCLUSION: CR is associated with reduced risk of mortality and major adverse cardiac events, irrespective of whether an anatomical or a score-based definition of incomplete revascularization is used, and this magnitude of risk relates to degree of CR. These results have important implications for the interventional management of patients with multivessel coronary artery disease.

15 Review Epidemiology and pathogenesis of diffuse obstructive coronary artery disease: the role of arterial stiffness, shear stress, monocyte subsets and circulating microparticles. 2016

Brown, Richard A / Shantsila, Eduard / Varma, Chetan / Lip, Gregory Y H. ·a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , UK. · b Cardiology Department, City Hospital , Birmingham , UK. ·Ann Med · Pubmed #27282244.

ABSTRACT: Despite falling age-adjusted mortality rates coronary artery disease (CAD) remains the leading cause of death worldwide. Advanced diffuse CAD is becoming an important entity of modern cardiology as more patients with historical revascularisation no longer have suitable anatomy for additional procedures. Advances in the treatment of diffuse obstructive CAD are hampered by a poor understanding of its development. Although the likelihood of developing clinically significant (obstructive) CAD is linked to traditional risk factors, the morphology of obstructive CAD among individuals is highly variable - some patients have diffuse stenotic disease, while others have a focal stenosis. This is challenging to explain in mechanistic terms as vascular endothelium is equally exposed to injury stimulants. Patients with diffuse disease are at high risk of adverse outcomes, particularly if unsuitable for revascularisation. We searched multiple electronic databases (MEDLINE, EMBASE and the Cochrane Database) and reviewed the epidemiology, pathogenesis and prognosis relating to advanced diffuse CAD with particular focus on the role of endothelial shear stress, large artery stiffness, monocyte subsets and circulating microparticles. Key messages Although traditional CAD risk factors correlate strongly with disease severity, significant individual variation in disease morphology exists. Advanced, diffuse CAD is difficult to treat effectively and can significantly impair quality of life and increases mortality. The pathophysiology associated with the progression of CAD is the result of complex maladaptive interaction between the endothelium, cells of the immune system and patterns of blood flow.

16 Review Revascularization for Left Anterior Descending Artery Stenosis: A Review of the Evidence That Supports Practice. 2016

Kinnaird, Tim / Anderson, Richard / Ossei-Gerning, Nicholas / Mamas, Mamas A / Ludman, Peter / Moat, Neil. ·From the *Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, UK; †Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK; ‡Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK; and §Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sidney Street, London, UK. ·Cardiol Rev · Pubmed #26751264.

ABSTRACT: Disease of the proximal left anterior descending (LAD) artery is a common pathological finding often combined with disease in other coronary arteries. In this article, we review specifically the evidence (and the guidelines arising from the data) for lesions isolated to the proximal LAD only. Critical review of the data reveals limitations with few trials that reflect contemporary practice. Much of the data are observational rather than from randomized trials, and therefore subject to bias. We identified 2 randomized trials of drug-eluting stents versus left internal mammary artery grafting for isolated lesions of the proximal LAD. One reported no difference in major adverse cardiovascular events, but at an early timepoint (6 months), which is likely to be too early to reveal treatment differences. In the second trial, target lesion revascularization excess was noted in the drug-eluting stent arm. Therefore, at the current time, there are little data available to inform interventional cardiologists as to the best revascularization strategy for isolated lesions of the proximal LAD. Further randomized, controlled trials are needed.

17 Review Coronary artery disease in the military patient. 2015

Parsons, Iain / White, S / Gill, R / Gray, H H / Rees, P. ·Department of Critical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UK. · Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. · Department of Regional Occupational Health, Queen Elizabeth Memorial Health Centre, Tidworth, UK. · Department of Cardiology, University Hospital Southampton NHS Foundation Trust & Civilian Consultant Advisor to the British Army, Southampton, UK. · Department of Cardiology, Barts Health NHS Trust & Academic Department of Military Medicine, London, UK. ·J R Army Med Corps · Pubmed #26246347.

ABSTRACT: Ischaemic heart disease is the most common cause of sudden death in the UK, and the most common cardiac cause of medical discharge from the Armed Forces. This paper reviews current evidence pertaining to the diagnosis and management of coronary artery disease from a military perspective, encompassing stable angina and acute coronary syndromes. Emphasis is placed on the limitations inherent in the management of acute coronary syndromes in the deployed environment. Occupational issues affecting patients with coronary artery disease are reviewed. Consideration is also given to the potential for coronary artery disease screening in the military, and the management of modifiable cardiovascular disease risk factors, to help decrease the prevalence of coronary artery disease in the military population.

18 Review Structure and functioning of a multidisciplinary 'Heart Team' for patients with coronary artery disease: rationale and recommendations from a joint BCS/BCIS/SCTS working group. 2015

Luckraz, Heyman / Norell, Michael / Buch, Mamta / James, Rachael / Cooper, Graham. ·Heart and Lung Centre, Wolverhampton, UK heymanluckraz@aol.com. · Heart and Lung Centre, Wolverhampton, UK. · University Hospital of South Manchester NHS Foundation Trust, Manchester, UK. · Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. · Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. ·Eur J Cardiothorac Surg · Pubmed #25762394.

ABSTRACT: The decision-making process in the management of patients with ischaemic heart disease has historically been the responsibility of the cardiologist and encompasses medical management, percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Currently, there is significant geographical variability in the PCI:CABG ratio. There are now emerging recommendations that this decision-making process should be carried out through a multidisciplinary approach, namely the Heart Team. This work was carried out on behalf of The British Cardiovascular Society (BCS), Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) and British Cardiovascular Intervention Society (BCIS). This manuscript sets out the principles for the functioning of the Heart Team. This work has been approved by the Executive Committees of BCS/BCIS/SCTS.

19 Review Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment? 2015

Bashir, Ahmed / Moody, William E / Edwards, Nicola C / Ferro, Charles J / Townend, Jonathan N / Steeds, Richard P. ·Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. · Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom; Clinical Cardiovascular Science, School of Clinical & Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom. · Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. · Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. Electronic address: rick.steeds@uhb.nhs.uk. ·Am J Kidney Dis · Pubmed #25754074.

ABSTRACT: Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.

20 Review Monocytes in coronary artery disease and atherosclerosis: where are we now? 2013

Ghattas, Angie / Griffiths, Helen R / Devitt, Andrew / Lip, Gregory Y H / Shantsila, Eduard. ·University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. ·J Am Coll Cardiol · Pubmed #23973684.

ABSTRACT: Despite improvements in interventional and pharmacological therapy of atherosclerotic disease, it is still the leading cause of death in the developed world. Hence, there is a need for further development of effective therapeutic approaches. This requires better understanding of the molecular mechanisms and pathophysiology of the disease. Atherosclerosis has long been identified as having an inflammatory component contributing to its pathogenesis, whereas the available therapy primarily targets hyperlipidemia and prevention of thrombosis. Notwithstanding a pleotropic anti-inflammatory effect to some therapies, such as acetyl salicylic acid and the statins, none of the currently approved medicines for management of either stable or complicated atherosclerosis has inflammation as a primary target. Monocytes, as representatives of the innate immune system, play a major role in the initiation, propagation, and progression of atherosclerosis from a stable to an unstable state. Experimental data support a role of monocytes in acute coronary syndromes and in outcome post-infarction; however, limited research has been done in humans. Analysis of expression of various cell surface receptors allows characterization of the different monocyte subsets phenotypically, whereas downstream assessment of inflammatory pathways provides an insight into their activity. In this review we discuss the functional role of monocytes and their different subpopulations in atherosclerosis, acute coronary syndromes, cardiac healing, and recovery with an aim of critical evaluation of potential future therapeutic targets in atherosclerosis and its complications. We will also discuss technical difficulties of delineating different monocyte subpopulations, understanding their differentiation potential and function.

21 Review Heart failure in East Asia. 2013

Guo, Yutao / Lip, Gregory Y H / Banerjee, Amitava. ·University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. ·Curr Cardiol Rev · Pubmed #23597295.

ABSTRACT: Heart failure (HF) carries a major burden of disease in East Asia, with high associated risk of mortality and morbidity. In recent decades, the epidemiology of HF has changed with social and economical development in East Asia. The burden of HF is still severe in East Asia. The prevalence of HF ranges from 1.3% to 6.7% throughout the region. As aetiological factors, ischaemic heart disease has increased and valvular disease reduced in most East Asian countries. Diuretics are the most commonly used drugs (51.0%-97%), followed by renin-angiotensin system (RAS) inhibitors (59%-77%), with angiotensin-converting enzyme inhibitors, ACEI, (32%-52%) and has angiotensin-2 receptor blockers, ARBs (31%-44%) in similar proportions. Betablocker use has also increased in recent years. Total mortality from HF ranges from 2% to 9% in China, Taiwan, Singapore, Thailand, and Japan. Age>65 years, diabetes mellitus, anaemia, renal dysfunction and atrial fibrillation (AF) are associated with adverse outcome. More prospective, region-specific data are still required, particularly regarding new drug therapies such as eplerenone and ivabradine.

22 Review Heart failure therapy in patients with coronary artery disease. 2013

Taylor, Clare J / Hobbs, F D Richard. ·Primary Care Clinical Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom. ·Curr Opin Pharmacol · Pubmed #23540585.

ABSTRACT: Heart failure and coronary artery disease share many risk factors. Coronary artery disease often pre-dates the development of heart failure with reduced ejection fraction. A diagnosis of heart failure should be considered in any patient with a history of coronary artery disease who presents with breathlessness, ankle oedema or fatigue. Several therapies, such as renin-angiotensin antagonists and B blockers, have been proven to improve survival in patients with heart failure with reduced ejection fraction but evidence for effectiveness in heart failure with preserved ejection fraction is lacking. The management of heart failure and coronary artery disease overlaps considerably but can also be conflicting. Optimal risk factor management is key to preventing progression to heart failure in patients with coronary artery disease.

23 Review Multimodality imaging in heart failure patients. 2013

Steeds, Richard P. ·Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. rick.steeds@uhb.nhs.uk ·Curr Opin Cardiol · Pubmed #23295552.

ABSTRACT: PURPOSE OF REVIEW: Imaging plays a central role in the diagnosis, assessment of cause and guiding treatment in heart failure. Several modalities are available that are of relevance in patients with heart failure, although echocardiography continues to be the method of choice due to widespread availability, good safety profile and low cost. RECENT FINDINGS: Echocardiography is appropriate in diagnosis of heart failure when placed in clinical context and supported by measurement of biomarkers. New methods of diagnosis of heart failure with preserved ejection fraction are emerging. The role of cardiovascular magnetic resonance (CMR) continues to expand in assessing cause of heart failure, with simpler methods for assessment of myocardial deformation and extracellular fibrosis. These progressively supplant the use of cardiac catheterization, although the value of myocardial viability assessment is now questionable. As utilization of cardiac resynchronization therapy continues to grow, the role of dyssynchrony beyond the ECG is being re-evaluated. SUMMARY: Echocardiography remains at the forefront in heart failure, although CMR is complementary and the role of invasive cardiac catheterization may be diminishing.

24 Review Aspirin and aspirin resistance in coronary artery disease. 2013

Kasmeridis, Charalampos / Apostolakis, Stavros / Lip, Gregory Y H. ·University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. ·Curr Opin Pharmacol · Pubmed #23294895.

ABSTRACT: Aspirin is still the mainstay of antiplatelet therapy in the secondary prevention of coronary artery disease. However certain patients do not benefit from the antithrombotic effects of aspirin. The phenomenon of so-called aspirin resistance can be considered from the clinical and laboratory perspective. A variety of methods have emerged for the laboratory diagnosis of aspirin resistance. None of them is considered ideal as they provide conflicting information with significant inter-individual variability and weak correlation between them. With the mechanisms of aspirin resistance not fully understood and the phenomenon commonly observed in individuals with poor compliance, the existence of aspirin resistance has been challenged. The aim of this review is to present recent data on the impact of aspirin resistance in primary and secondary prevention of coronary artery disease.

25 Review Novel oral anticoagulants: focus on the direct factor Xa inhibitor darexaban. 2012

Apostolakis, Stavros / Lip, Gregory Y H. ·University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. stavrosapos@hotmail.com ·Expert Opin Investig Drugs · Pubmed #22616561.

ABSTRACT: INTRODUCTION: Inhibition of the pathways of anticoagulation is widely used for the prevention and treatment of arterial and venous thrombosis. Vitamin K antagonists (VKAs) have been the mainstay of oral anticoagulation for more than 60 years. Their safety and effectiveness have been established in multiple clinical trials, for a variety of clinical indications. However, there are several limitations to the use of VKAs including delayed onset of action and dosage titration, numerous food and drug interactions and need for regular laboratory monitoring. To overcome some of the limitations of traditional agents, new oral anticoagulants (OACs) have been developed and evaluated. AREAS COVERED: In the present review article, the pharmacokinetic properties of darexaban are presented, along with the available preliminary clinical data. The performance of darexaban in respect to safety and efficacy compared with its competitors is further discussed. EXPERT OPINION: Darexaban is a potent direct factor Xa inhibitor that demonstrated impressive pharmacokinetic properties in pre-clinical studies. It was further successfully evaluated in the ONYX program for the prevention of venous thromboembolism in patients undergoing hip replacement. Finally, in the Phase II RUBY-1 trial, darexaban was tested on the top of standard antiplatelet therapy for the prevention of ischemic events in acute coronary syndrome (ACS) patients. Despite the fact that darexaban had a relatively uneventful clinical evaluation program, its further development was recently discontinued. This decision could probably reflect the non-favorite results in commercially attractive indications, such as secondary prevention post-ACS and the increased competition for less common or short-term indications such stroke prevention in AF or VTE prophylaxis respectively.

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