Faculty Bibliography
Searched for:
in-biosketch:true
person:bergej03
Total Results:
438
Hospital Readmission After Perioperative Acute Myocardial Infarction Associated With Noncardiac Surgery
PMCID:5995321
PMID: 29525764
ISSN: 1524-4539
CID: 2994102
Evaluation of clinical outcomes among nonvalvular atrial fibrillation patients treated with rivaroxaban or warfarin, stratified by renal function

BACKGROUND:Renal dysfunction increases the risk of thromboembolic and bleeding events in patients with nonvalvular atrial fibrillation (NVAF). MATERIALS AND METHODS/METHODS:Adult NVAF patients with ≥ 6 months prior to first warfarin or rivaroxaban dispensing were selected from the IMS Health Real-World Data Adjudicated Claims database (05/2011 - 06/2015) with electronic medical records. Ischemic stroke events, thromboembolic events (venous thromboembolism, myocardial infarction, or ischemic stroke), and major bleeding events were compared between patients by renal function identified by 1) relevant ICD-9-CM diagnosis codes and 2) estimated creatinine clearance (eCrCl). Baseline confounders were adjusted using inverse probability of treatment weights. RESULTS:The diagnosis-based analysis included 39,872 rivaroxaban and 48,637 warfarin users (3,572 and 8,230 with renal dysfunction, respectively). The eCrCl-based analysis included 874 rivaroxaban and 1,069 warfarin users (66 and 208 with eCrCl < 60 mL/min, respectively). In the diagnosis-based analysis, rivaroxaban users with renal dysfunction had a significantly lower stroke rate (HR = 0.55, p = 0.0004) compared to warfarin users; rivaroxaban users with and without renal dysfunction had significantly lower thromboembolic event rates (HR = 0.62, p < 0.0001; and HR = 0.64, p < 0.0001, respectively), and similar major bleeding rates to warfarin users. In the eCrCl-based analysis, rivaroxaban users with eCrCl ≥ 60 mL/min had a significantly lower thromboembolic event rate, but other outcomes were not statistically significant. CONCLUSION/CONCLUSIONS:Rivaroxaban-treated NVAF patients with diagnosed renal dysfunction had a significantly lower stroke rate compared to warfarin-treated patients. Regardless of renal dysfunction diagnoses, rivaroxaban users had lower thromboembolic event rates compared to warfarin users, and a similar rate of major bleeding. eCrCl-based analysis was limited by a small sample size.
.
PMID: 29231162
ISSN: 0301-0430
CID: 3053272
Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial
BACKGROUND:Patients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. METHODS:A prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies. Patients were randomized in a 1:1:1 fashion to usual care (UC; group A, n = 134), in-hospital CV prevention consult (PC; group B, n = 130), or PC plus behavioral intervention program (telephone-based motivational interviewing and optional tailored text messages) (group C, n = 133). The primary end point was the Δ change in non-high-density lipoprotein cholesterol (non-HDL-C) from baseline to 6 month. RESULTS:The mean age was 64.6 ± 10.8 years, 23.7% were female, and 31.5% were nonwhite. After 6 months, the absolute difference in non-HDL-C for all participants was -19.8 mg/dL (95% CI -24.1 to -15.6, P < .001). There were no between-group differences in the primary end point for the combined PC groups (B and C) versus UC, with a Δ adjusted between group difference of -5.5 mg/dL (95% CI -13.1 to 2.1, P = .16). Patients in the PC groups were more likely to be on high-intensity statins at 6 months (52.9% vs 38.1%, P = .01). After excluding participants with baseline non-HDL-C <100 mg/dL (initial exclusion criterion), Δ non-HDL-C and Δ low-density lipoprotein cholesterol were improved in the PC groups compared to UC (non-HDL-C -8.13 mg/dL [-16.00 to -0.27], P = .04; low-density lipoprotein cholesterol -7.87mg/dL [-15.10 to -0.64], P = .03). CONCLUSIONS:Although non-HDL-C reduction at 6 months following a nonurgent CV procedure was not significant in the overall cohort, an increased uptake in high-potency statins may translate into improved long-term health outcomes and cost reductions.
PMID: 29754664
ISSN: 1097-6744
CID: 3114632
Arteriosclerosis, thrombosis, & vascular biology. 2018:Conference:(Vascular).DOI: 10.1161/atvb.38.suppl-2D1.150
Monocyte-platelet aggregates correlate with the prevalence and severity of aortic aneurysms [Meeting Abstract]
Objective: To determine whether monocyte-platelet aggregates (MPA) correlate with aortic aneurysm (AA) prevalence and severity. BACKGROUND: Inflammation and intraluminal thrombus are key hallmarks of complex AA. While monocytes fuel inflammation in AA, the contribution of platelets is unknown. We hypothesized that increased platelet activity yields to MPA that drive AA development and indicate disease severity.
Method(s): Blood was collected from 49 symptomatic patients admitted for aneurysm repair procedures (8 thoracic and 41 abdominal) and 36 matched controls. All subjects were on aspirin monotherapy. Platelet responsiveness to agonists was characterized by light transmission aggregometry. Flow cytometry analysis allowed leukocytes (CD45+)/monocytes (CD14+)-platelet (CD61+) aggregates (LPA/MPA) measurements in the blood and profiled MPA in post-surgical aneurysm tissues.
Result(s): Platelet aggregation in response to ADP (57% vs. 35% aggregation, p<0.001) and arachidonic acid (24% vs. 16% aggregation, p=0.03), was increased in patients with AA versus controls. LPA (17.7 vs 6.2% CD61+ leukocytes, p=0.002) and MPA (18.0 vs 7.2% CD61+ Monocytes, p=0.008) were robustly increased in AA vs controls. MPA but not LPA was strongly and positively associated with AA size (p<0.0001). To delve into the role of MPA in situ in AA sac, platelets and tissue macrophage activation was characterized. Compared to the non-diseased part of the aorta, diseased section had significantly higher platelet infiltration (7.0% vs 1.2% CD61+ cells, p=0.006) and interaction with CD68+ tissue macrophages (8.3% vs. 0.7%, CD61+ macrophages p=0.03). Notably, macrophages highly expressed the adhesion protein, ICAM-1, in the diseased part (39.6 vs 3.3% in the non-diseased section, p<0.001) which further increased to 69.4% (p=0.01) when macrophages were in contact with platelets.
Conclusion(s): Our data highlights MPA as a novel mediator valuable to predict AA prevalence and severity
Method(s): Blood was collected from 49 symptomatic patients admitted for aneurysm repair procedures (8 thoracic and 41 abdominal) and 36 matched controls. All subjects were on aspirin monotherapy. Platelet responsiveness to agonists was characterized by light transmission aggregometry. Flow cytometry analysis allowed leukocytes (CD45+)/monocytes (CD14+)-platelet (CD61+) aggregates (LPA/MPA) measurements in the blood and profiled MPA in post-surgical aneurysm tissues.
Result(s): Platelet aggregation in response to ADP (57% vs. 35% aggregation, p<0.001) and arachidonic acid (24% vs. 16% aggregation, p=0.03), was increased in patients with AA versus controls. LPA (17.7 vs 6.2% CD61+ leukocytes, p=0.002) and MPA (18.0 vs 7.2% CD61+ Monocytes, p=0.008) were robustly increased in AA vs controls. MPA but not LPA was strongly and positively associated with AA size (p<0.0001). To delve into the role of MPA in situ in AA sac, platelets and tissue macrophage activation was characterized. Compared to the non-diseased part of the aorta, diseased section had significantly higher platelet infiltration (7.0% vs 1.2% CD61+ cells, p=0.006) and interaction with CD68+ tissue macrophages (8.3% vs. 0.7%, CD61+ macrophages p=0.03). Notably, macrophages highly expressed the adhesion protein, ICAM-1, in the diseased part (39.6 vs 3.3% in the non-diseased section, p<0.001) which further increased to 69.4% (p=0.01) when macrophages were in contact with platelets.
Conclusion(s): Our data highlights MPA as a novel mediator valuable to predict AA prevalence and severity
EMBASE:628632330
ISSN: 1524-4636
CID: 4021672
Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial
Importance:Clinical practice guidelines support home-based exercise for patients with peripheral artery disease (PAD), but no randomized trials have tested whether an exercise intervention without periodic medical center visits improves walking performance. Objective:To determine whether a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching improves walking ability over 9 months in patients with PAD. Design, Setting, and Participants:Randomized clinical trial conducted at 3 US medical centers. Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to home-based exercise vs usual care for 9 months. Final follow-up was on December 5, 2017. Interventions:The exercise intervention group (n = 99) received 4 weekly medical center visits during the first month followed by 8 months of a wearable activity monitor and telephone coaching. The usual care group (n = 101) received no onsite sessions, active exercise, or coaching intervention. Main Outcomes and Measures:The primary outcome was change in 6-minute walk distance at 9-month follow-up (minimal clinically important difference [MCID], 20 m). Secondary outcomes included 9-month change in subcomponents of the Walking Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical functioning score, Patient-Reported Outcomes Measurement Information System (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS satisfaction with social roles questionnaire, PROMIS pain interference questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively measured physical activity. Results:Among 200 randomized participants (mean [SD] age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care group (difference, -8.9 m; 95% CI, -26.0 to 8.2 m; P = .31). The exercise intervention worsened the PROMIS pain interference score, mean change from baseline to 9 months was 0.7 in the intervention group vs -2.8 in the usual care group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores. Conclusions and Relevance:Among patients with PAD, a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching, compared with usual care, did not improve walking performance at 9-month follow-up. These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD. Trial Registration:clinicaltrials.gov Identifier: NCT02462824.
PMCID:5933394
PMID: 29710165
ISSN: 1538-3598
CID: 3061592
Coronary angiography in patients with perioperative myocardial injury after non-cardiac surgery [Meeting Abstract]
Background: Perioperative myocardial infarction (MI) is a common cardiovascular complication of surgery that occurs in up to 5.0% of patients at increased cardiovascular risk. We sought to determine coronary artery anatomy in patients referred for invasive coronary angiography for the evaluation of perioperative MI or myocardial injury after non-cardiac surgery (MINS). Methods: Patients with perioperative MI or MINS who were referred for coronary angiography at NYU Langone Medical Center were retrospectively identified from January 1, 2013 to December 31, 2015. Demographic, clinical, and angiographic characteristics were obtained via electronic medical record review. Results: A total of 31 patients with perioperative MI (n=28) or MINS (n=3) were referred for invasive coronary angiography. The mean age was 70+/-10 years, 52% were male, and cardiovascular risk factors were common (Table). Obstructive coronary artery disease (CAD) was identified in 24 patients (77.4%) and a chronic total occlusion (CTO) of a major epicardial vessel was identified in 11 patients. A total of 15 patients (48.4%) underwent PCI. Among patients without obstructive CAD, angiography revealed mild CAD (stenosis <40% in major epicardial coronary vessels) in the majority (71.4%) of cases. Conclusion: Obstructive CAD is present in the majority of patients with perioperative MI or MINS, with CTO in nearly half of these patients. One-quarter of patients did not have obstructive CAD, and the mechanism of myocardial injury in these patients is unknown. This study reaffirms the benefit of empiric guidelinedirected medical therapy for CAD in patients with perioperative MI or MINS, despite limited evidence from clinical trials in this population
EMBASE:622145773
ISSN: 1522-726x
CID: 3130492
HOSPITAL READMISSION FOLLOWING PERIOPERATIVE ACUTE MYOCARDIAL INFARCTION ASSOCIATED WITH NON-CARDIAC SURGERY [Meeting Abstract]
ISI:000429659705123
ISSN: 0735-1097
CID: 3055212
PERIPHERAL VASCULAR DISEASE RISK EQUIVALENCE IN DIABETES DEPENDS ON CONCOMITANT RISK FACTORS [Meeting Abstract]
ISI:000429659704089
ISSN: 0735-1097
CID: 3055222
ASSOCIATIONS BETWEEN CONVENTIONAL CARDIOVASCULAR RISK FACTORS AND RISK OF PERIOPERATIVE ACUTE MYOCARDIAL INFARCTION AFTER NON-CARDIAC SURGERY [Meeting Abstract]
ISI:000429659703516
ISSN: 0735-1097
CID: 3055252
THE IMPACT OF CARDIOVASCULAR DISEASE RISK FACTORS ON ATHEROSCLEROSIS IN PSORIASIS [Meeting Abstract]
ISI:000429659703510
ISSN: 0735-1097
CID: 3055262
