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Cytokine signature in convalescent SARS-CoV-2 patients with inflammatory bowel disease receiving vedolizumab

Dallari, Simone; Martinez Pazos, Vicky; Munoz Eusse, Juan; Wellens, Judith; Thompson, Craig; Colombel, Jean-Frederic; Satsangi, Jack; Cadwell, Ken; Wong, Serre-Yu; ,
While differential antibody responses SARS-CoV-2 in patients with inflammatory bowel disease (IBD) receiving infliximab and vedolizumab are well-characterized, the immune pathways underlying these differences remain unknown. Prior to COVID-19 vaccine development, we screened 235 patients with IBD receiving biological therapy for antibodies to SARS-CoV-2 and measured serum cytokines. In seropositive patients, we prospectively collected clinical data. We found a cytokine signature in patients receiving vedolizumab who are seropositive compared with seronegative for SARS-CoV-2 antibodies that may be linked to repeated SARS-CoV-2 infections. However, there were no differences between seropositive and seronegative patients receiving infliximab. In this single-center cohort of patients with IBD with anti-SARS-CoV-2 antibodies at the onset of the COVID-19 pandemic, and therefore without influence of vaccination, there is a cytokine signature in patients receiving vedolizumab but not infliximab. These findings lay the groundwork for further studies on immune consequences of viral infection in patients with IBD, which is postulated to evolve from aberrant host-microbe responses.
PMCID:10761911
PMID: 38168138
ISSN: 2045-2322
CID: 5626042

Safety and efficacy of dedicated guidewire, microcatheter, and guide catheter extension technologies for chronic total coronary occlusion revascularization: Primary results of the Teleflex Chronic Total Occlusion Study

Kandzari, David E; Alaswad, Khaldoon; Jaffer, Farouc A; Brilakis, Emmanouil; Croce, Kevin; Kearney, Kathleen; Spaedy, Anthony; Yeh, Robert; Thompson, Craig; Nicholson, William; Wyman, R Michael; Riley, Robert; Lansky, Alexandra; Buller, Christopher; Karmpaliotis, Dimitrios
BACKGROUND:Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited. METHODS:A prospective, multicenter, single-arm study was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization utilizing specialized guidewires, microcatheters and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events, MACE). RESULTS:The prevalence of diabetes was 32.7%; prior MI, 48.0%; and previous bypass surgery, 32.7%. Average (mean ± standard deviation) CTO length was 46.9 ± 20.5 mm, and mean J-CTO score was 1.9 ± 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Device utilization included: support microcatheter, 100%; guide catheter extension, 64.0%; and mean number of study guidewires/procedure was 4.8 ± 2.6. Overall, procedural success was achieved in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and in-hospital MACE was 19.3%. Achievement of TIMI grade 2 or 3 flow was observed in 93.3% of patients. Crossing strategies included antegrade (54.0%), retrograde (1.3%) and combined antegrade/retrograde techniques (44.7%). Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 (10.7%) patients. CONCLUSIONS:In a multicenter, prospective registration study, favorable procedural success was achieved despite high lesion complexity using antegrade and retrograde guidewire maneuvers and with acceptable safety, yet with comparably higher risk than conventional non-CTO PCI.
PMID: 34582080
ISSN: 1522-726x
CID: 5067442

Invasive Management of Acute Myocardial Infarctions During the Initial Wave of the COVID-19 Pandemic

Talmor, Nina; Ramachandran, Abhinay; Brosnahan, Shari B; Shah, Binita; Bangalore, Sripal; Razzouk, Louai; Attubato, Michael; Feit, Frederick; Thompson, Craig; Smilowitz, Nathaniel R
BACKGROUND:The initial wave of the coronavirus disease 2019 (COVID-19) pandemic resulted in an influx of patients with acute viral illness and profound changes in healthcare delivery in New York City. The impact of this pandemic on the presentation and invasive management of acute myocardial infarction (MI) is not well described. METHODS:This single-center retrospective study compared patients with MI who underwent invasive coronary angiography at New York University from March-April 2020, during the peak of the first wave of the pandemic, with those presenting in March-April 2019. RESULTS:Only 35 patients with MI underwent angiography during the study period in 2020 vs 109 patients in 2019. No differences in comorbidities or baseline medications were identified. The proportion of patients with ST-segment elevation MI (STEMI) was higher in 2020 than in 2019 (48.6% vs 24.8%, respectively; P=.01). Median peak troponin concentration was higher (14.5 ng/mL vs 2.9 ng/mL; P<.01) and left ventricular ejection fraction was lower (43.34% vs 51.1%; P=.02) during the pandemic. Among patients with non-STEMI, time from symptom onset to presentation was delayed in 2020 compared with 2019 (median, 24 hours vs 10 hours; P=.04). CONCLUSION/CONCLUSIONS:There was a dramatic decrease in the number of patients with MI undergoing coronary angiography during the first wave of the COVID-19 pandemic. Of those who presented, patients tended to seek care later after symptom onset and had excess myocardial injury. These data indicate a need for improved patient education to ensure timely cardiovascular care during public health emergencies.
PMID: 34866048
ISSN: 1557-2501
CID: 5085552

TCT-414 Safety and Efficacy of Dedicated Guidewire, Microcatheter, and Guide Catheter Extension Technologies for Chronic Total Coronary Occlusion Revascularization: Primary Results of the Teleflex Chronic Total Occlusion Study [Meeting Abstract]

Kandzari, D; Alaswad, K; Jaffer, F A; Brilakis, E; Croce, K; Kearney, K; Spaedy, A; Yeh, R; Thompson, C; Nicholson, W; Wyman, R M; Riley, R; Lansky, A; Karmpaliotis, D
Background: Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited.
Method(s): A prospective, multicenter, single-arm trial was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization using specialized guidewires, microcatheters, and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events [MACE]).
Result(s): The prevalence of diabetes was 32.7%, of prior MI was 48.0%, and of previous bypass surgery was 32.7%. Average (mean +/- SD) CTO length was 46.9 +/- 20.5 mm, and mean J-CTO score was 1.9 +/- 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Devices used included guidewire support microcatheters in 100% and guide catheter extensions in 64.0%, and the mean number of CTO-specific guidewires per procedure was 5.11 +/- 3.52. Overall, procedural success was observed in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and the rate of absence of in-hospital MACE was 80.7%. Methods included antegrade (54.0%), retrograde (1.3%), and combined antegrade and retrograde techniques (44.7%). Total mean procedure time was 149 +/- 91 minutes, mean radiation dose was 2,219 +/- 1,608 mGy, and mean contrast utilization was 205 +/- 95 mL. Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 patients (10.7%).
Conclusion(s): In a multicenter, prospective registration trial, favorable procedural success and early clinical outcomes were achieved in a patient population with high lesion complexity using contemporary techniques and application of dedicated CTO guidewires, microcatheters, and guide catheter extensions. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)
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EMBASE:2015286074
ISSN: 1558-3597
CID: 5180222

Intermediate procedural and health status outcomes and the clinical care pathways after chronic total occlusion angioplasty: A report from the OPEN-CTO (outcomes, patient health status, and efficiency in chronic total occlusion hybrid procedures) study

Sapontis, James; Hirai, Taishi; Patterson, Christian; Gans, Benjamin; Yeh, Robert W; Lombardi, William; Karmpaliotis, Dimitri; Moses, Jeffrey; Nicholson, William J; Pershad, Ashish; Wyman, R Michael; Spaedy, Anthony; Cook, Stephen; Doshi, Parag; Federici, Robert; Thompson, Craig A; Nugent, Karen; Gosch, Kensey; Grantham, J Aaron; Salisbury, Adam C
BACKGROUND:No previous reports have described the comprehensive care pathways involved in chronic total occlusion percutaneous coronary intervention (CTO PCI). METHODS:In a study of 1,000 consecutive patients undergoing CTO PCI using hybrid approach, a systematic algorithm of selecting CTO PCI strategies, the procedural characteristics, complication rates, and patient reported health status outcomes through 12 months were assessed. RESULTS:Technical success of the index CTO PCI was 86%, with 89% of patients having at least one successful CTO PCI within 12 months. A total of 13.8% underwent CTO PCI of another vessel or reattempt of index CTO PCI within 1 year. At 1 year, the unadjusted major adverse cardiac and cerebral event (MACCE) rate was lower in patients with successful index CTO PCI compared to patients with unsuccessful index CTO PCI (9.4% vs. 14.6%, p = .04). The adjusted hazard ratios of myocardial infarction and death at 12 months were numerically lower in patients with successful index CTO PCI, compared to patients with unsuccessful index CTO PCI. Patients with successful index CTO PCI reported significantly greater improvement in health status throughout 12-months compared to patients with unsuccessful index CTO PCI. CONCLUSION/CONCLUSIONS:CTO-PCI in the real-world often require treatment of second CTO, non-CTO PCI or repeat procedures to treat initially unsuccessful lesions. Successful CTO PCI is associated with numerically lower MACCE at 1 year and persistent symptomatic improvement compared to unsuccessful CTO PCI. Understanding the relationship between the care pathways following CTO PCI and health status benefit requires further study.
PMID: 33108056
ISSN: 1522-726x
CID: 4735432

Misconception in CrossBoss/stingray catheter use-clarification from the hybrid group [Letter]

Pershad, Ashish; Grantham, James A; Thompson, Craig A; Lombardi, William L
PMID: 33586303
ISSN: 1522-726x
CID: 4836332

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review

Wu, Eugene B; Brilakis, Emmanouil S; Mashayekhi, Kambis; Tsuchikane, Etsuo; Alaswad, Khaldoon; Araya, Mario; Avran, Alexandre; Azzalini, Lorenzo; Babunashvili, Avtandil M; Bayani, Baktash; Behnes, Michael; Bhindi, Ravinay; Boudou, Nicolas; Boukhris, Marouane; Bozinovic, Nenad Z; Bryniarski, Leszek; Bufe, Alexander; Buller, Christopher E; Burke, M Nicholas; Buttner, Achim; Cardoso, Pedro; Carlino, Mauro; Chen, Ji-Yan; Christiansen, Evald Hoej; Colombo, Antonio; Croce, Kevin; de Los Santos, Felix Damas; de Martini, Tony; Dens, Joseph; di Mario, Carlo; Dou, Kefei; Egred, Mohaned; Elbarouni, Basem; ElGuindy, Ahmed M; Escaned, Javier; Furkalo, Sergey; Gagnor, Andrea; Galassi, Alfredo R; Garbo, Roberto; Gasparini, Gabriele; Ge, Junbo; Ge, Lei; Goel, Pravin Kumar; Goktekin, Omer; Gonzalo, Nieves; Grancini, Luca; Hall, Allison; Hanna Quesada, Franklin Leonardo; Hanratty, Colm; Harb, Stefan; Harding, Scott A; Hatem, Raja; Henriques, Jose P S; Hildick-Smith, David; Hill, Jonathan M; Hoye, Angela; Jaber, Wissam; Jaffer, Farouc A; Jang, Yangsoo; Jussila, Risto; Kalnins, Artis; Kalyanasundaram, Arun; Kandzari, David E; Kao, Hsien-Li; Karmpaliotis, Dimitri; Kassem, Hussien Heshmat; Khatri, Jaikirshan; Knaapen, Paul; Kornowski, Ran; Krestyaninov, Oleg; Kumar, A V Ganesh; Lamelas, Pablo Manuel; Lee, Seung-Whan; Lefevre, Thierry; Leung, Raymond; Li, Yu; Li, Yue; Lim, Soo-Teik; Lo, Sidney; Lombardi, William; Maran, Anbukarasi; McEntegart, Margaret; Moses, Jeffrey; Munawar, Muhammad; Navarro, Andres; Ngo, Hung M; Nicholson, William; Oksnes, Anja; Olivecrona, Goran K; Padilla, Lucio; Patel, Mitul; Pershad, Ashish; Postu, Marin; Qian, Jie; Quadros, Alexandre; Rafeh, Nidal Abi; RÃ¥munddal, Truls; Prakasa Rao, Vithala Surya; Reifart, Nicolaus; Riley, Robert F; Rinfret, Stephane; Saghatelyan, Meruzhan; Sianos, George; Smith, Elliot; Spaedy, Anthony; Spratt, James; Stone, Gregg; Strange, Julian W; Tammam, Khalid O; Thompson, Craig A; Toma, Aurel; Tremmel, Jennifer A; Trinidad, Ricardo Santiago; Ungi, Imre; Vo, Minh; Vu, Vu Hoang; Walsh, Simon; Werner, Gerald; Wojcik, Jaroslaw; Wollmuth, Jason; Xu, Bo; Yamane, Masahisa; Ybarra, Luiz F; Yeh, Robert W; Zhang, Qi
The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.
PMID: 34412818
ISSN: 1558-3597
CID: 4990492

Impact of COVID-19 pandemic on STEMI care: An expanded analysis from the United States

Garcia, Santiago; Stanberry, Larissa; Schmidt, Christian; Sharkey, Scott; Megaly, Michael; Albaghdadi, Mazen S; Meraj, Perwaiz M; Garberich, Ross; Jaffer, Farouc A; Stefanescu Schmidt, Ada C; Dixon, Simon R; Rade, Jeffrey J; Smith, Timothy; Tannenbaum, Mark; Chambers, Jenny; Aguirre, Frank; Huang, Paul P; Kumbhani, Dharam J; Koshy, Thomas; Feldman, Dmitriy N; Giri, Jay; Kaul, Prashant; Thompson, Craig; Khalili, Houman; Maini, Brij; Nayak, Keshav R; Cohen, Mauricio G; Bangalore, Sripal; Shah, Binita; Henry, Timothy D
OBJECTIVE:To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care. BACKGROUND:We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data. METHODS:Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), and average door to balloon (D2B) times. Two periods, January 2019-February 2020 and March-April 2020, were defined to represent periods before (BC) and after (AC) initiation of pandemic mitigation measures, respectively. A generalized estimating equations approach was used to estimate the change in response variables at AC from BC. RESULTS:Compared to BC, the AC period was characterized by a marked reduction in the number of activations for STEMI (29%, 95% CI:18-38, p < .001), number of activations leading to angiography (34%, 95% CI: 12-50, p = .005) and number of activations leading to PPCI (20%, 95% CI: 11-27, p < .001). A decline in STEMI activations drove the reductions in angiography and PPCI volumes. Relative to BC, the D2B times in the AC period increased on average by 20%, 95%CI (-0.2 to 44, p = .05). CONCLUSIONS:The COVID-19 Pandemic has adversely affected many aspects of STEMI care, including timely access to the cardiac catheterization laboratory for PPCI.
PMID: 32767652
ISSN: 1522-726x
CID: 4555742

Dual-Guide Triple-Kiss Technique for Left Main Trifurcation

Bangalore, Sripal; Alkhalil, Ahmad; Feit, Frederick; Keller, Norma; Thompson, Craig
PMID: 34052154
ISSN: 1876-7605
CID: 4890682

Future Perspectives of Left Main Revascularization Trials [Letter]

Kuno, Toshiki; Ueyama, Hiroki; Rao, Sunil V; Cohen, Mauricio G; Tamis-Holland, Jacqueline E; Thompson, Craig; Takagi, Hisato; Bangalore, Sripal
PMID: 33902823
ISSN: 1097-6744
CID: 4853132