Faculty Bibliography
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803
Newer Generation Ultra-Thin Strut Drug-Eluting Stents versus Older Second-Generation Thicker Strut Drug-Eluting Stents for Coronary Artery Disease: A Meta-Analysis of Randomized Trials
PMID: 29945934
ISSN: 1524-4539
CID: 3199142
Age, Blood Pressure Targets, and Guidelines: Rift Between Those Who Preach, Those Who Teach, and Those Who Treat?
PMID: 29986957
ISSN: 1524-4539
CID: 3192262
Future Direction for Using Artificial Intelligence to Predict and Manage Hypertension
PURPOSE OF REVIEW/OBJECTIVE:Evidence that artificial intelligence (AI) is useful for predicting risk factors for hypertension and its management is emerging. However, we are far from harnessing the innovative AI tools to predict these risk factors for hypertension and applying them to personalized management. This review summarizes recent advances in the computer science and medical field, illustrating the innovative AI approach for potential prediction of early stages of hypertension. Additionally, we review ongoing research and future implications of AI in hypertension management and clinical trials, with an eye towards personalized medicine. RECENT FINDINGS/RESULTS:Although recent studies demonstrate that AI in hypertension research is feasible and possibly useful, AI-informed care has yet to transform blood pressure (BP) control. This is due, in part, to lack of data on AI's consistency, accuracy, and reliability in the BP sphere. However, many factors contribute to poorly controlled BP, including biological, environmental, and lifestyle issues. AI allows insight into extrapolating data analytics to inform prescribers and patients about specific factors that may impact their BP control. To date, AI has been mainly used to investigate risk factors for hypertension, but has not yet been utilized for hypertension management due to the limitations of study design and of physician's engagement in computer science literature. The future of AI with more robust architecture using multi-omics approaches and wearable technology will likely be an important tool allowing to incorporate biological, lifestyle, and environmental factors into decision-making of appropriate drug use for BP control.
PMID: 29980865
ISSN: 1534-3111
CID: 3186322
When Guideline Authors Ignore Their Own Guidelines [Letter]
PMID: 29844149
ISSN: 1524-4563
CID: 3154872
European heart journal. Quality of care & clinical outcomes. 2018:4(4):258-266.DOI: 10.1093/ehjqcco/qcy023
Cardiovascular Hazards of Insufficient Treatment of Depression Among Patients with Known Cardiovascular Disease: A Propensity Score Adjusted Analysis: Bangalore et al, CVD Hazards of Insufficient Depression Treatment
Aims/UNASSIGNED:The association between depression care adequacy and the risk of subsequent adverse cardiovascular disease (CVD) outcomes among patients with a previous diagnosis of myocardial infarction (MI) or stroke is not well defined. Methods and Results/UNASSIGNED:This retrospective cohort study used commercial claims data (2010-2015) and included adults with newly diagnosed and treated MDD following an initial MI or stroke diagnosis. Depression care adequacy was assessed during the 3-month period following the MDD diagnosis index date using two measures: antidepressant dosage adequacy and duration adequacy. Cox models adjusted for the propensity of receiving adequate depression care were used to compare the risk of a composite CVD outcome (MI, stroke, congestive heart failure [CHF], and angina) as well as each individual CVD event between patients receiving adequate versus inadequate depression care. 1568 patients were included in the final cohort. Of these, 937 (59.8%) were categorized as receiving inadequate depression care based on at least 1 of the 2 treatment adequacy criteria. Propensity score adjusted Cox models showed that depression care inadequacy was associated with a significantly higher risk of the composite CVD endpoint (HR, 1.20; 95% CI, 1.04-1.39), stroke (HR 1.20, 95% CI, 1.02-1.42) and angina (HR 1.95, 95% CI, 1.21-3.16) with no significant interaction based on cohort included (MI vs. stroke) or the definition of inadequate depression (dose vs. duration inadequacy) (Pinteraction>0.05). Conclusions/UNASSIGNED:Inadequate MDD care was associated with a higher risk of adverse CVD events. These findings reveal a significant unmet clinical need in patients with post-MI or post-stroke MDD that may impact CVD outcomes.
PMID: 29893803
ISSN: 2058-1742
CID: 3155172
Prasugrel in the Elderly [Editorial]
PMID: 29866773
ISSN: 1524-4539
CID: 3143952
International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: Rationale and design
BACKGROUND:Prior trials comparing a strategy of optimal medical therapy with or without revascularization have not shown that revascularization reduces cardiovascular events in patients with stable ischemic heart disease (SIHD). However, those trials only included participants in whom coronary anatomy was known prior to randomization and did not include sufficient numbers of participants with significant ischemia. It remains unknown whether a routine invasive approach offers incremental value over a conservative approach with catheterization reserved for failure of medical therapy in patients with moderate or severe ischemia. METHODS:The ISCHEMIA trial is a National Heart, Lung, and Blood Institute supported trial, designed to compare an initial invasive or conservative treatment strategy for managing SIHD patients with moderate or severe ischemia on stress testing. Five thousand one-hundred seventy-nine participants have been randomized. Key exclusion criteria included estimated glomerular filtration rate (eGFR) <30 mL/min, recent myocardial infarction (MI), left ventricular ejection fraction <35%, left main stenosis >50%, or unacceptable angina at baseline. Most enrolled participants with normal renal function first underwent blinded coronary computed tomography angiography (CCTA) to exclude those with left main coronary artery disease (CAD) and without obstructive CAD. All randomized participants receive secondary prevention that includes lifestyle advice and pharmacologic interventions referred to as optimal medical therapy (OMT). Participants randomized to the invasive strategy underwent routine cardiac catheterization followed by revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery, when feasible, as selected by the local Heart Team to achieve optimal revascularization. Participants randomized to the conservative strategy undergo cardiac catheterization only for failure of OMT. The primary endpoint is a composite of cardiovascular (CV) death, nonfatal myocardial infarction (MI), hospitalization for unstable angina, hospitalization for heart failure, or resuscitated cardiac arrest. Assuming the primary endpoint will occur in 16% of the conservative group within 4 years, estimated power exceeds 80% to detect an 18.5% reduction in the primary endpoint. Major secondary endpoints include the composite of CV death and nonfatal MI, net clinical benefit (primary and secondary endpoints combined with stroke), angina-related symptoms and disease-specific quality of life, as well as a cost-effectiveness assessment in North American participants. Ancillary studies of patients with advanced chronic kidney disease and those with documented ischemia and non-obstructive coronary artery disease are being conducted concurrently. CONCLUSIONS:ISCHEMIA will provide new scientific evidence regarding whether an invasive management strategy improves clinical outcomes when added to optimal medical therapy in patients with SIHD and moderate or severe ischemia.
PMCID:6005768
PMID: 29778671
ISSN: 1097-6744
CID: 3129632
ISCHEMIA: Establishing the Primary End Point
PMCID:5967873
PMID: 29752391
ISSN: 1941-7705
CID: 3101702
The Potential Effects of New Stent Platforms for Coronary Revascularization in Patients With Diabetes
Coronary artery disease in patients with diabetes mellitus (DM) is characterized by extensive atherosclerosis, longer lesions, and diffuse distal disease. Consequently, these patients have worse outcomes after coronary revascularization, regardless of the modality used. Traditionally, coronary artery bypass grafting (CABG) has been regarded as more effective than percutaneous coronary intervention (PCI) in patients with DM, likely because of more complete revascularization and protection against disease progression in the bypass segment. Revascularization with balloon angioplasty, bare-metal stents, and first-generation drug-eluting stents have all been shown to be inferior to CABG in patients with DM. Current professional society guidelines reflect these findings, strongly recommending CABG over PCI in this setting. Newer stent platforms, however, have challenged this notion. The use of thinner struts, biocompatible polymer coating, and newer antiproliferative agents have improved the rates of cardiovascular events in patients with DM revascularized percutaneously. Since the publication of current guidelines, new studies suggested acceptable outcomes in patients with DM revascularized with second-generation drug-eluting stents, even though these conclusions are drawn from small subgroup analyses or nonrandomized studies. Robust registry data suggest similar mortality with lower rates of stroke after PCI compared with surgery, at the expense of increased rates of repeat revascularization. If complete revascularization can be achieved, similar rates of myocardial infarction are also observed. Therefore, contemporary revascularization in patients with DM with multivessel coronary artery disease should involve a multidisciplinary approach, in which interventional cardiologists and cardiac surgeons involve their patients to individualize treatment choices, and balance the risks and effectiveness of each modality.
PMID: 29731024
ISSN: 1916-7075
CID: 3101162
European heart journal. Quality of care & clinical outcomes. 2018:4(3):173-179.DOI: 10.1093/ehjqcco/qcy018
Cardiac Rehabilitation Fitness Changes and Subsequent Survival
Aims/UNASSIGNED:Assessments of cardiac rehabilitation (CR) in coronary heart disease (CHD) cohorts usually examine mortality in aggregate. The current study examines the prognosis and characteristics of patients who enrolled and completed CR, stratified by their level of improvement in cardiorespiratory fitness (CRF) by examining the characteristics, outcomes and predictors of non-response in CRF (NonRes) compared to low-responders (LowRes) and high-Responders (HighRes) after CR. Methods And Results/UNASSIGNED:1171 CHD patients were referred for a phase II CR program after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention between January 1, 2000 and June 30, 2013 underwent cardiopulmonary exercise testing before and after CR. This cohort was divided according to absolute improvements in CRF [i.e., change in peak oxygen consumption expressed in ml•kg-1•min-1]. Mortality was analyzed after 0.5 to 13.4 years of follow-up (mean 6.4 years). 266 (23%) of subjects were NonRes. After adjustment for body mass index, age, gender, left ventricular ejection fraction and baseline CRF, NonRes and LowRes had a statistically significant 3-fold and 2-fold higher mortality, respectively, when compared to HighRes (HighRes: 8% vs LowRes: 17% vs NonRes: 22%; p < 0.001). Age, female gender, baseline CRF, hostility and presence of diabetes were significant predictors of NonRes and LowRes. In addition, higher waist circumference was a predictor of NonRes. Conclusions/UNASSIGNED:Significant proportions of subjects referred to CR have no/low improvement in CRF and higher associated mortality risks. Greater attention is required to increase improvements in CRF following CR and avoid NonRes.
PMID: 29701805
ISSN: 2058-1742
CID: 3053222
