Try a new search

Format these results:

Searched for:

person:shanij01

Total Results:

33


Comparison of Metoprolol versus Carvedilol After Acute Myocardial Infarction

Zaatari, Ghaith; Fintel, Dan J; Subacius, Haris; Germano, Joseph J; Shani, Jacob; Goldberger, Jeffrey J
Beta-blockers are typically prescribed following myocardial infarction (MI), but no specific beta-blocker is recommended. Of 7,057 patients enrolled in the OBTAIN multi-center registry of patients with acute MI, 4142 were discharged on metoprolol and 1487 on carvedilol. Beta-blocker dose was indexed to the target daily dose used in randomized clinical trials (metoprolol-200 mg; carvedilol-50 mg), reported as %. Beta-blocker dosage groups were >0%-12.5% (n=1428), >12.5%-25% (n=2113), >25%-50% (n=1392), and >50% (n=696). The Kaplan-Meier method was used to calculate three-year survival. Correction for baseline differences was achieved by multivariable adjustment. Patients treated with carvedilol were older (64.4 versus 63.3 years) and had more comorbidities: hypertension, diabetes, prior MI, congestive heart failure, reduced left ventricular ejection fraction, and a longer length of stay. Mean doses for metoprolol and carvedilol did not significantly differ (37.2±27.8% and 35.8±31.0%, respectively). The 3-year survival estimates were 88.2% and 83.5% for metoprolol and carvedilol, respectively, with an unadjusted HR=0.72 (p<0.0001), but after multivariable adjustment HR=1.073 (p=0.43). Patients in the >12.5-25% dose category had improved survival compared to other dose categories. Subgroup analysis of patients with left ventricular ejection fraction ≤40%, showed worse survival with metoprolol versus carvedilol (adjusted HR=1.281; 95% CI: 1.024-1.602, p=0.03). In patients with left ventricular ejection fraction >40%, there were no differences in survival with carvedilol versus metoprolol. In conclusion, overall survival after acute MI was similar for patients treated with metoprolol or carvedilol, but may be superior for carvedilol in patients with left ventricular ejection fraction ≤40%.
PMID: 33621525
ISSN: 1879-1913
CID: 4794492

Patent foramen ovale closure versus medical therapy for cryptogenic stroke: An updated systematic review and meta-analysis

Goel, Sunny; Patel, Shanti; Zakin, Elina; Pasam, Ravi Teja; Gotesman, Joseph; Malik, Bilal Ahmad; Ayzenberg, Sergey; Frankel, Robert; Shani, Jacob
OBJECTIVES/OBJECTIVE:The objective of this study was to compare safety and efficacy of patent foramen ovale (PFO) closure compared with medical therapy in patients with cryptogenic stroke (CS). BACKGROUND:The role of PFO closure in preventing recurrent stroke in patients with prior CS has been controversial. METHODS:We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials that compared device closure with medical management and reported on subsequent stroke and adverse events. Event rates were compared using a forest plot of relative risk using a random-effects model assuming interstudy heterogeneity. RESULTS: = 27%, P = 0.002). The presence/absence of atrial septal aneurysm (P = 0.52) had no effect on the outcome. CONCLUSION/CONCLUSIONS:PFO closure is associated with a significant reduction in the risk of stroke compared to medical management. However, it causes an increased risk of atrial fibrillation.
PMCID:7136357
PMID: 32248916
ISSN: 2213-3763
CID: 4374352

Prasugrel-Induced Thrombocytopenia After Percutaneous Coronary Intervention

Hashmi, Arsalan Talib; Sabharwal, Nitin; Saxena, Abhinav; Saradna, Arjun; Kamholz, Stephan L; Hollander, Gerald; Shani, Jacob
PMID: 30908301
ISSN: 1536-3686
CID: 3776702

Comparison of single versus dual antiplatelet therapy after TAVR: A systematic review and meta-analysis

Raheja, Hitesh; Garg, Aakash; Goel, Sunny; Banerjee, Kinjal; Hollander, Gerald; Shani, Jacob; Mick, Stephanie; White, Jonathan; Krishnaswamy, Amar; Kapadia, Samir
OBJECTIVE:We aim to evaluate the efficacy of dual versus single anti-platelet therapy (SAPT) after TAVR through a systematic review and meta-analysis of published research. BACKGROUND:Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is a commonly practiced strategy after transcatheter aortic valve replacement (TAVR). However, there is lack of sufficient evidence supporting this approach. METHOD:We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials (RCT) and observational studies comparing DAPT with SAPT post TAVR. Event rates were compared using a forest plot of relative risk with 95% confidence intervals using a random-effects model assuming inter-study heterogeneity. RESULTS:A total of six studies (3 RCTs and 3 observational studies, n = 840) were included in the final analysis. Compared to SAPT, DAPT was associated with increased risk of significant bleeding (life threatening and major) [RR = 2.52 (95% CI 1.62-3.92, P < 0.0001)] with the number needed to harm for major or life-threatening bleeding calculated to be 10.4. There was no significant difference in the incidence of stroke [RR = 1.06 (95% CI, 0.43-2.60, P = 0.90)], spontaneous myocardial infarction [RR = 2.08 (95% CI, 0.56-7.70, P = 0.27)] and all-cause mortality [RR = 1.18 (95% CI, 0.68-2.05, P = 0.56] in the DAPT and SAPT groups. CONCLUSION:In this small meta-analysis of DAPT versus SAPT after TAVR, DAPT did not prevent stroke, myocardial infarction or death while the risk of bleeding was higher. Results from ongoing trials are awaited to determine the best anti-thrombotic approach after TAVR.
PMID: 29516608
ISSN: 1522-726x
CID: 5491322

Unusual Sign from an Unusual Cause: Wellens' Syndrome due to Myocardial Bridging [Case Report]

Ambesh, Paurush; Sharma, Dikshya; Kapoor, Aditya; Hess, Aviva-Tobin; Shetty, Vijay; Hollander, Gerald; Shani, Jacob; Kamholz, Stephan; Saradna, Arjun; Akkad, Isaac; Obiagwu, Chukwudi
It is vital to recognize correctly, chest pain of cardiac etiology. Most commonly, it is because of blood supply-demand inequity in the myocardium. However, the phenomenon of myocardial bridging as a cause of cardiac chest pain has come to attention reasonably recently. Herein, a coronary artery with a normal epicardial orientation develops a transient myocardial course. If the cardiac muscle burden is substantial, the respective artery gets compressed during each cycle of systole, thereby impeding blood flow in the artery. Hence, myocardial bridging has been attributed to as a rare cause of angina. In this case report, the authors discuss a patient in whom myocardial bridging turned out to be an elusive cause of angina. We wish to underscore the importance of being clinically mindful of myocardial bridging when assessing a patient with angina.
PMCID:6083606
PMID: 30147963
ISSN: 2090-6404
CID: 4599362

Pseudo atrial septum defect from a Eustachian valve on transesophageal echocardiogram [Case Report]

Akkad, Isaac; Wartak, Siddharth; Moskovits, Manfred; Sadiq, Adnan; Frankel, Robert; Hollander, Gerald; Shani, Jacob
PMID: 27423786
ISSN: 1880-344x
CID: 4599332

Novel Oral Anticoagulants in Atrial Fibrillation: Update on Apixaban

Mezue, Kenechukwu; Obiagwu, Chukwudi; John, Jinu; Sharma, Abhishek; Yang, Felix; Shani, Jacob
Almost 800,000 new or recurrent strokes occur every year. Atrial fibrillation, the most common cardiac arrhythmia, is a major risk factor for stroke, accounting for 15-20% of ischemic strokes. Apixaban is a direct inhibitor of Factor Xa that was approved in December 2012 by the US Food and Drug Administration (FDA) for the prevention of stroke in patients with non-valvular atrial fibrillation. It is part of a family of novel oral anticoagulants (NOACs) which has advantage over warfarin of less dosing variability, rapid onset of action and no INR monitoring required. Apixaban showed superiority to warfarin in both primary efficacy and primary safety outcomes by simultaneously showing both significantly lower rates of strokes and systemic embolism and a reduced risk of major clinical bleeding in clinical trials. Warfarin remains the anticoagulant of choice for patients with prosthetic heart valves and significant mitral stenosis. There are currently no head-to-head studies that directly compare the different NOACs with one another, but it is expected that there will be more trials in the future that will explore this comparison. Dabigatran is the only NOAC with an FDA approved reversal agent. However, a reversal agent for apixaban is being developed and was successful in recent clinical trials. This review summarizes the clinical trial data on apixaban for atrial fibrillation, compares apixaban to other NOACs and discusses apixaban use in clinical practice.
PMCID:5324317
PMID: 27450450
ISSN: 1875-6557
CID: 5375892

A Rare Case of Left Ventricular Non-Compaction Cardiomyopathy [Meeting Abstract]

Le, Jeffrey; Brejt, Shelly; Chadha, Sameer; Montemarano, Nadine; Kerstein, Joshua; Shani, Jacob
ISI:000400116000243
ISSN: 0012-3692
CID: 4662622

Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus

Wartak, Siddharth; Akkad, Isaac; Sadiq, Adnan; Crooke, Gregory; Moskovits, Manfred; Frankel, Robert; Hollander, Gerald; Shani, Jacob
A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy.
PMCID:5005593
PMID: 27610249
ISSN: 2090-6404
CID: 4599342

The Sudden Appearance of a Mobile Mass in the Ascending Aorta on Transesophageal Echocardiography After Transcatheter Aortic Valve Replacement [Case Report]

Trunfio, Giuseppe; Konstadt, Steven; Ribakove, Greg; Crooke, Greg; Frankel, Robert; Shani, Jacob; Sadiq, Adnan; Ovanez, Christopher; Feierman, Dennis E
PMID: 26579653
ISSN: 1526-7598
CID: 2040422