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Coronary Artery Disease: HELP
Articles from Philadelphia
Based on 304 articles published since 2008
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These are the 304 published articles about Coronary Artery Disease that originated from Philadelphia during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13
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 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).

3 Guideline ACR Appropriateness Criteria 2017

Anonymous3940905 / Akers, Scott R / Panchal, Vandan / Ho, Vincent B / Beache, Garth M / Brown, Richard K J / Ghoshhajra, Brian B / Greenberg, S Bruce / Hsu, Joe Y / Kicska, Gregory A / Min, James K / Stillman, Arthur E / Stojanovska, Jadranka / Abbara, Suhny / Jacobs, Jill E. ·Principal Author, VA Medical Center, Philadelphia, Pennsylvania. Electronic address: akerssco@me.com. · Research Author, Internal Medicine Resident, Henry Ford Allegiance Health, Jackson, Michigan. · Panel Vice-Chair, Uniformed Services University of the Health Sciences, Bethesda, Maryland. · University of Louisville School of Medicine, Louisville, Kentucky. · University Hospital, Ann Arbor, Michigan. · Massachusetts General Hospital, Boston, Massachusetts. · Arkansas Children's Hospital, Little Rock, Arkansas. · Kaiser Permanente, Los Angeles, California. · University of Washington, Seattle, Washington. · Cedars Sinai Medical Center, Los Angeles, California; American College of Cardiology. · Emory University Hospital, Atlanta, Georgia. · University of Michigan Health System, Ann Arbor, Michigan. · Specialty Chair, UT Southwestern Medical Center, Dallas, Texas. · Panel Chair, New York University Medical Center, New York, New York. ·J Am Coll Radiol · Pubmed #28473096.

ABSTRACT: In patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD), imaging has major and diverse roles. First, imaging is valuable in determining and documenting the presence, extent, and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions. Second, imaging findings are important in determining the course of management of patients with suspected chronic myocardial ischemia and better defining those patients best suited for medical therapy, angioplasty/stenting, or surgery. Third, imaging is also necessary to determine the long-term prognosis and likely benefit from various therapeutic options by evaluating ventricular function, diastolic relaxation, and end-systolic volume. Imaging studies are also required to demonstrate other abnormalities, such as congenital/acquired coronary anomalies and severe left ventricular hypertrophy, that can produce angina in the absence of symptomatic coronary obstructive disease due to atherosclerosis. Clinical risk assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk for developing CAD. 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.

4 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.

5 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 --

6 Guideline The primary and secondary prevention of coronary artery disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). 2008

Becker, Richard C / Meade, Thomas W / Berger, Peter B / Ezekowitz, Michael / O'Connor, Christopher M / Vorchheimer, David A / Guyatt, Gordon H / Mark, Daniel B / Harrington, Robert A. ·Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: becke021@mc.duke.edu. · Non Comm Disease Epidemiology, London School of Hygiene Tropical, London, UK. · Geisinger Center for Health Research, Danville, PA. · Lankenau Institute for Medical Research, Wynnewood, PA. · Duke University Medical Center, Division of Cardiology, Durham, NC. · Mount Sinai Medical Center, New York, NY. · McMaster University Health Sciences Centre, Hamilton, ON, Canada. · Duke University Medical School, Durham, NC. · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. ·Chest · Pubmed #18574278.

ABSTRACT: The following chapter devoted to antithrombotic therapy for chronic coronary artery disease (CAD) is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggests that individual patient values may lead to different choices (for a full understanding of the grading see the "Grades of Recommendation" chapter by Guyatt et al in this supplement, CHEST 2008; 133[suppl]:123S-131S). Among the key recommendations in this chapter are the following: for patients with non-ST-segment elevation (NSTE)-acute coronary syndrome (ACS) we recommend daily oral aspirin (75-100 mg) [Grade 1A]. For patients with an aspirin allergy, we recommend clopidogrel, 75 mg/d (Grade 1A). For patients who have received clopidogrel and are scheduled for coronary bypass surgery, we suggest discontinuing clopidogrel for 5 days prior to the scheduled surgery (Grade 2A). For patients after myocardial infarction, after ACS, and those with stable CAD and patients after percutaneous coronary intervention (PCI), we recommend daily aspirin (75-100 mg) as indefinite therapy (Grade 1A). We recommend clopidogrel in combination with aspirin for patients experiencing ST-segment elevation (STE) and NSTE-ACS (Grade 1A). For patients with contraindications to aspirin, we recommend clopidogrel as monotherapy (Grade 1A). For long-term treatment after PCI in patients who receive antithrombotic agents such as clopidogrel or warfarin, we recommend aspirin (75 to 100 mg/d) [Grade 1B]. For patients who undergo bare metal stent placement, we recommend the combination of aspirin and clopidogrel for at least 4 weeks (Grade 1A). We recommend that patients receiving drug-eluting stents (DES) receive aspirin (325 mg/d for 3 months followed by 75-100 mg/d) and clopidogrel 75 mg/d for a minimum of 12 months (Grade 2B). For primary prevention in patients with moderate risk for a coronary event, we recommend aspirin, 75-100 mg/d, over either no antithrombotic therapy or vitamin K antagonist (Grade 1A).

7 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 --

8 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 --

9 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 --

10 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 --

11 Editorial A Potential Role for Aromatase Levels in Coronary Heart Disease. 2016

Ehrlich, Garth D. ·1 Department of Microbiology and Immunology, Center for Genomic Sciences and Center for Advanced Microbial Processing, Institute of Molecular Medicine and Infectious Diseases, Drexel University College of Medicine, Philadelphia, PA. · 2 Department of Otolaryngology-Head and Neck Surgery, Center for Genomic Sciences and Center for Advanced Microbial Processing, Institute of Molecular Medicine and Infectious Diseases, Drexel University College of Medicine, Philadelphia, PA. ·Genet Test Mol Biomarkers · Pubmed #26780325.

ABSTRACT: -- No abstract --

12 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 --

13 Editorial Pediatric Heart Transplant Recipients and Cardiac Allograft Vasculopathy: The Importance of Hemodynamics. 2015

Eisen, Howard J. ·Division of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: heisen@drexelmed.edu. ·J Am Coll Cardiol · Pubmed #26227195.

ABSTRACT: -- No abstract --

14 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.

15 Editorial Optimal blood pressure targets in older adults: how low is low enough? 2014

Gradman, Alan H. ·Temple University School of Medicine (Clinical Campus), Pittsburgh, Pennsylvania. Electronic address: gradmana@temple.edu. ·J Am Coll Cardiol · Pubmed #25145523.

ABSTRACT: -- No abstract --

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

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

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

17 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.

18 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 --

19 Review Dysfunctional HDL in diabetes mellitus and its role in the pathogenesis of cardiovascular disease. 2018

Srivastava, Rai Ajit K. ·Integrated Pharma Solutions, Philadelphia, PA, USA. ajitsriva@gmail.com. · Department of Pharmacology, Gemphire Therapeutics, 17199 Laurel Park, Livonia, MI, USA. ajitsriva@gmail.com. ·Mol Cell Biochem · Pubmed #28828539.

ABSTRACT: Coronary artery disease, the leading cause of death in the developed and developing countries, is prevalent in diabetes mellitus with 68% cardiovascular disease (CVD)-related mortality. Epidemiological studies suggested inverse correlation between HDL and CVD occurrence. Therefore, low HDL concentration observed in diabetic patients compared to non-diabetic individuals was thought to be one of the primary causes of increased risks of CVD. Efforts to raise HDL level via CETP inhibitors, Torcetrapib and Dalcetrapib, turned out to be disappointing in outcome studies despite substantial increases in HDL-C, suggesting that factors beyond HDL concentration may be responsible for the increased risks of CVD. Therefore, recent studies have focused more on HDL function than on HDL levels. The metabolic environment in diabetes mellitus condition such as hyperglycemia-induced advanced glycation end products, oxidative stress, and inflammation promote HDL dysfunction leading to greater risks of CVD. This review discusses dysfunctional HDL as one of the mechanisms of increased CVD risks in diabetes mellitus through adversely affecting components that support HDL function in cholesterol efflux and LDL oxidation. The dampening of reverse cholesterol transport, a key process that removes cholesterol from lipid-laden macrophages in the arterial wall, leads to increased risks of CVD in diabetic patients. Therapeutic approaches to keep diabetes under control may benefit patients from developing CVD.

20 Review Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. 2017

Tse, Gary / Gong, Mengqi / Nunez, Julia / Sanchis, Juan / Li, Guangping / Ali-Hasan-Al-Saegh, Sadeq / Wong, Wing Tak / Wong, Sunny Hei / Wu, William K K / Bazoukis, George / Yan, Gan-Xin / Lampropoulos, Konstantinos / Baranchuk, Adrian M / Tse, Lap Ah / Xia, Yunlong / Liu, Tong / Woo, Jean / Anonymous1210925. ·Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China. · Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China. · Cardiology Department, Hospital Clínico Universitario, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain; CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain. · Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. · School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China. · Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Department of Anesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China. · Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece. · Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China. · Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada. · Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. · Department of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China. · Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China. Electronic address: liutongdoc@126.com. · Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China. ·J Am Med Dir Assoc · Pubmed #29079033.

ABSTRACT: BACKGROUND: Frailty has been identified as a risk factor for mortality. However, whether frailty increases mortality risk in patients undergoing percutaneous coronary intervention (PCI) has been controversial. Therefore, we conducted a systematic review and meta-analysis of the frailty measures and mortality outcomes in this setting. METHODS: PubMed and EMBASE were searched until July 23, 2017 for studies evaluating the association between frailty measures and mortality in individuals who have undergone PCI. RESULTS: A total of 141 entries were retrieved from our search strategy. A total of 8 studies involving 2332 patients were included in the final meta-analysis (mean age: 69 years; 68% male, follow-up duration was 30 ± 28 months). Frailty was a significant predictor of all-cause mortality after PCI, with a hazard ratio (HR) of 2.97 [95% confidence interval (CI) 1.56-5.66, P = .001]. This was substantial heterogeneity present (I CONCLUSIONS: Frailty leads to significantly higher mortality rates in patients who have undergone PCI. Both the Fried score and Canadian Study of Health and Aging Clinical Frailty Scale are powerful predictors of mortality. These findings may support the notion that an alternative to invasive strategy should be considered in frail patients who are indicated for revascularization.

21 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.

22 Review The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis. 2017

Gupta, Ankur / Lau, Emily / Varshney, Ravi / Hulten, Edward A / Cheezum, Michael / Bittencourt, Marcio S / Blaha, Michael J / Wong, Nathan D / Blumenthal, Roger S / Budoff, Matthew J / Umscheid, Craig A / Nasir, Khurram / Blankstein, Ron. ·Cardiovascular Imaging Program, Division of Cardiovascular Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Cardiovascular Imaging Program, Division of Cardiovascular Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Walter Reed National Military Medical Center, Washington, DC. · Cardiovascular Imaging Program, Division of Cardiovascular Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Fort Belvoir Community Hospital, Fort Belvoir, Virginia. · Cardiovascular Imaging Program, Division of Cardiovascular Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein and Faculdade Israelita de Ciencias da Saude Albert Einstein, Sao Paulo, Brazil. · John Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. · University of California, Irvine, Irvine, California. · Harbor-University of California at Los Angeles, Torrance, California. · Penn Medicine, Philadelphia, Pennsylvania. · John Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Baptist Health South Florida, Miami, Florida. · Cardiovascular Imaging Program, Division of Cardiovascular Medicine and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rblankstein@bwh.harvard.edu. ·JACC Cardiovasc Imaging · Pubmed #28797402.

ABSTRACT: OBJECTIVES: The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography. BACKGROUND: Detection of calcified coronary plaque could serve as a motivational tool for physicians and patients to intensify preventive therapies. METHODS: We searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random effects model. RESULTS: After a review of 6,256 citations and 54 full-text papers, 6 studies (11,256 participants, mean follow-up time: 1.6 to 6.0 years) were included. Pooled estimates of the odds of aspirin initiation (OR: 2.6; 95% confidence interval [CI]: 1.8 to 3.8), lipid-lowering medication initiation (OR: 2.9; 95% CI: 1.9 to 4.4), blood pressure-lowering medication initiation (OR: 1.9; 95% CI: 1.6 to 2.3), lipid-lowering medication continuation (OR: 2.3; 95% CI: 1.6 to 3.3), increase in exercise (OR: 1.8; 95% CI: 1.4 to 2.4), and dietary change (OR: 1.9; 95% CI: 1.5 to 2.5) were higher in individuals with nonzero CAC versus zero CAC scores, but not for aspirin or blood pressure-lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors. CONCLUSIONS: This systematic review and meta-analysis suggests that nonzero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease.

23 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.

24 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.

25 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.

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